4091 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. .(Complete in Duplicate) 6 Jf ?� Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct anj,install the work herein escribed. This application is made in compliance with County Ordinance No. 549, ,�- � JOB ADDRESS AND LO ATION = 'Tr 44 '------ ------------P --- - -- --- Owner's Name----------Liza- ----- - ---------- 23--- te^ -*----�-r---�---Y1-G-�wX�} ---7--------------------------------------------------r----------�•1--+•'-............ (' ` Address___.__._ _; -`�- 6 �- ;5 --------- Contractor's Name - ------------------------------------------- Phone--- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ . Motel ❑ Other ❑ Number of living units: ________ Number of bedrooms _-Z___ Number of baths ._l___ Lot size --------- � ✓Sp�-------_______________ Water Supply: Public system ❑ Community system ❑ Private ® Depth to Water Table.T--a-_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam IZ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No ® New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_________________Distance from foundation----•--------------.Material----____-____________-_.___.___________----_-_ ❑ No. of compartments--------------------------Size--------------------------------liquid depth--------------------------Capacity----------------------- Disposal Field: Distance from nearest well--_/Pin_,___.Distance from foundation____.0__'D'_�__.___Distance to nearest lot line_____4. D4 Number of lines______________ _____i%_ Length of each line___:__________ _ Zo_______-Width of trench----A_-_____--_____-_---._--____ 1 Type of filter material----(R _______Depth of filter material______10__ _____•__Total length-----------d-;p____________________ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line_________________ ❑ Number of pits----------------------Lining material--------_--------------Size: Diameter----•-----------------_Depth--------------------------------- Cesspool: Distance from nearest well----------------- from foundation---------- ----- Lining material_________-_-__-__---_--______________ ❑ Size: Diameter--------------------------------------Depth--------------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest—well-------------------------------------------------Distance from nearest building__-__-_____-________---__________________. ❑ Distance to nearest lotline------------------------------ -----------------------------•-------------------------------------------------------------------------------- Remodelin and/or repairing --------------------- ______ - A7 '� -�. •__ _•_-_.--_____--__ ..�a -+ ---- - ; ------------------------------ -----------------------------------=-----------------------f-- - - ---� -------------------------------------- ---------- -----------------------------------------------•--------------------------- ----------------------------------------------------------------------- hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. Ell. BDIem lN1 ____________________(Owner and/or Contractor) (Signed) ----- er --- By:-------------------- ------- -----------------------------------------(Ti+le)- � _ �- -------------- (Plot plan, showing size of lot, location of system in relay n to wells, buildings, etc., can be placed on reverse side). . FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---7'.--- ------------------------- --------------------------------------- --------------. DATE------------------- rr / REVIEWEDBY--------------------------------------------- ----------------- -------------------------------------------- ------ DATE---------------------------------------- BUILDING PERMIT ISSUED----------------------------------------------------------------•---- -------------------------------- DATE: Alterations and/or recommendations---------------------------------------------- --------------------------------•--------------------------- ---------------------- -----------•-----------• -_----------------------------------------------------•-------------------------------------------------------------------------------------------------------------- ------------------------------•------------------------------------.-----------------------•-----------------------------------------------------------------------------------------------•--------------------------•------- --------------------------------------------------------------------------------------------------------------- -------------------------------------------------- -------•---------------------------------- FINAL INSPECTION BY ----------------------- --- _ Date-------- SAN ------vSAN JOAQUIN LOCAL FkALTH 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-4-2M 8-51 Reyised W-2100 f