6917 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. Clete in Duplicate) t 11 (Complete l ' Date Issued .__.__!-/ Applica+ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 5 9. t JOB ADDRESS AND LOCATION--- -- --- ------- --------- Owner's Name- ----- --- ---•-- - ---- ---- -------- - - ----------------------- ---------------------------------- -------- Phone--------------------------------•-- Add ress----_ /�� i Name Y v-�."!�- ----------•----- ---------------------------------------- Contractor's - Phone _ R_2_. 1 -�F Installation will serve: Residence Z p_ r rT€n 'l�fbuse ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ 1 Number of living units: _1_-_ Number of bedrooms __Number of baths ./----- Lot size ----4._._0----� /----Z Water Supply: Public system ommunity system ❑ Private ❑ Depth to Water Table1_70__ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe dpasr❑ Previous Application Made: Yes ❑ No ew Construction: Yes ❑ No 6_,__ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Sep TA Distance from nearest well..:..............Distance from foundation-__--_--.__-___.__.Material---_-_--_-__.__--_.__-.__________.._-__..____-. No. of compartments----------------- -- -----Size--------------------------------Liquid depth--------- ----_---------Capacity---------------------- . fi Dispoo,sooal Field: Distance from nearest well!h451.4—_Distance from foundation__ ----------- Distance to nearest lot line____-____- L ...-.. Number of lines------�--- �-------------- Length of each line----=:��`-'�-.___-.-.Width of trench--�.�-`l__._---_-----..-•.- Type of filter material-t- __.----_____Depth of filter material- __-..Total length-----�j=i------------------- —Seepage Pif: Distance to nearest well1�1!"ti� --_Distance om fou ation___ �..-.__.Distance to nearest lot line--- z:__ Number of pits---.-1-------------Lining material_ Size: Diameter__% ------------Depth__,"O>—*--_-________-._--_-__. Cesspool: Distance from nearest well-----------------Distance from foundation................... Lining material__.-_...._.-__-_.._-___ ❑ Size: Diameter-------------------------- -----------.-Depth--------------------- -----------------------------Liquid Capacity-----------------------------gals. Privy:. Distance from nearest well-------__ ------------------------ --------------Distance from nearest building---------------------------------------.-. ❑ Distance to nearest lot line--=------------------------------------------ ----------------••----------------------------------------------------------------------------- Remodelingand/or repairing (describe):- - ------------------------------------------------------------------------------------------------------------------=----------------- ------------ ------------------------------------------------- ------------------------------------------------------------••--------------------------•-------....-----------------------------------•----------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, to I ws, and rjupA and egulations of the San Joaquin Local Health District. ntractor{Signed - -------------------- -- ---------- - ------------------------- - - ) ...- s -- - --------------------------- ----------------(Title)------ -------------------------------------------------------- By:. (Plot pian, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY / APPLICATION ACCEPTED BY---- -------------- ----------- -------------------------- ------------------------ DATE-------------//------- ---------- REVIEWEDBY-------------------------------- ------------------ --- ---------------------------------------------------------------------- DATE-------- •-------------------------------------------------- BUILDINGPERMIT ISSUED---------------•----------------------•----------------------------------------------------- -------._ DATE------------------------------------------------------------- Alterationsand/or recommendations:_------------ -------------------------- ------------ --•------------------•------------•-••----------•-----•-----------••------------------•---•------- ------------•----------------- ----------------------•---- ----------...----------•-----•----------•----•--•-•----•---------. ---------------------- ---------q- ---- ---- , -------------I --------------------------•---------------------------------------------------••---------------------- FINAL INSPECTION BY:..r! ----------------------------------------- Date. 1�' SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oat; Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E" 9-2M 145446 ATWOOO 12.54