3370 - Laserfiche WebLink

Home Browse Search

5114 APPLICATION FOR SANITATION PERMIT Permit No.3.-,��d_--.:__- (Complete in Duplicate) � Date Issued pplication 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. 549. JOB ADDRESS AND LOCATION..... _ _ i� Owner's Name------------------------------------ p�yr ►�"_ ...- �, rr_ = c1---- ------. Phone-- A---7 -- Address---------------- 2/ - .._a, t -. ��- --_.---`' Contractor's Name-•-----•---------------------- •--- C. --------------------------:----------------------------------- Phone----- -7_14D-2-------- Installation will serve: Residence K Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ i Number of living units: __I___ Number of bedrooms -__YNumber of baths _�.__- Lot size ______--•�t2_____-_�_____f QQ____.___ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table 'SIR ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe-Hardpan ❑ Previous Application Made: Yes ❑ No)3?, New Construction: Yes [�r. No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if publicseweris available within 200 feet.) Septic Tank: Distance from nearest well__&QO Distance from foundation-J_P-----------Material------_ _------------ _______ _.---___•-, �• �f -, •� No. of compartments---- -- -----------------Size.�?�-- --- ---_._--Liquid d � epth_ �t_ri-_-------Capacity-�? _��e Disposal Field: Distance from nearest well_ ©_t�Q.--Distance from foundation_��0...___--_-Distance to nearest lot line------ Number of lines----------- _ Length of each line___-_ ' i� ----�--a------- --- g -�---------------Width of trench---�+-�----- ----------------- Type of filter material_____lf.ly_R5____Depth of filter material---.__Z_�_'_ __.__Total length................. ---------------- Z_0------------ Seepage Pit: Distance to nearest well___ art -----Distance fr m foundation__--_-______------Distance to nearest lot line.... �' Number of pits______ ______________Lining material_ ' "_s�__.Size: Diameter_._-4`� .____Depth._..f _ _ _'_______._.-_____ Cesspool: Distance from nearest well-----------------Distance from foundation------------------..Lining material_---___________________.._.__-__--__ ❑ Size: Diameter--------------------------------------Depth--------------------------------------------- -----Liquid Capacity- ---------------- ---------gals. r Privy: Distance from nearest well-------------------------------------.-----------Distance from nearest building---------------------------------------__ ❑ Distance to nearest lot line--------------------------------------------------------------------------------------------------------------------------------------------- Remodelingand/or repairing (describe):-----------------------------••---------------------------------------------------------------- ---•--------------•---------------•--------------•-•-- ------------------------------•--•----------------------------------------------------------------------------------------------•----------------•----------------------------------_------•---------------------------------- ----------------------------------------------------------------------------------------------- ----------------•-•----------------------------------------------•-------------------------•----------------- ! hereby certify that I have prepared 's application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and re ilat� ns of the San J quin Local Health District. {Signed] -- - -----...r�...------------ .- -- -- ------------------------------------------------O Contractor ,E ! BY. � - -----11 �:`----_------------------- ---------------------------------------------------------------{Title)---------- ------•---------•---------------- - ----------------- (Plot plan, showing size of lot, I cation of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------------- --------------------------------------- DATE, 3._- 5 REVIEWEDBY------------------------------------- ----------------------------------------- ---------------------------------------------- DATE BUILDING PERMIT ISSUED---------- ------------------------------------------- ----------------------------------------------- DATE Alterations and/or recommendations:---------- ----•----------------------------- --------- -----------------•--•--------------------•---------------••----- ..._... -------------I-•---------------•---------------•---•--------------- -------------------------------- ------------------------•---------------------•-----•-----------------------------------------•------------------------- ---------•-------------------------- ----------------•------------------------------------------------------------------------------------------------------------- ----------------------------------------------•----- •------------------------------------------------------------------ -------------------------------------- -------------------------------------- -------------------------------------- - -------------------------------- -------------------------------------------------------- --- --- -- ----- ----- ---------------•--------•--•----------------- - -----•---------- -------- f /--------------- FINAL INSPECTION BY:. - ---------------- Date f y ----- ----- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 10-52 Revised W-2100