2363 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No, c,-If__QK __----- (Complete in Duplicate) Date Issued -6/-?_r `3 -' Application 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 C('unty Ordinance No. 549. JOB ADDRESS AND LOCATION---- /!_V,9_A✓------------------------------------------------------------------------------------------------- Owner's Name---------- 40-CY a'a —----------------------------------------------------------------------------------------------- Phone---- --- -4 Address----------------_----------- - ------ .---------------•-----------------------------------------------------------------------p---------------------•- • -j0hZ/7� /s� r�i0 •.'� �/��• ------------------------------- Phone ! T Contractor's Name --- -- Installation will serve: Residence [partment House ❑ Commercial ❑ " Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ______ Number of bedrooms -------- Number of baths ________ Lot size ---------------------------------------------------.-______ Water Supply: Public system [Community system ❑ Private ❑ Depth to Water Table _:'"___ it, Characterof soil to a depth of 3 feet:` Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay.❑ Adobe 2--*Hardpan ❑ Previous Application Made: Yes ❑ iNo ❑ New Construction: Yes ❑ No ❑ C� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) k Septic Tank: Distance from nearest well-________________Distance from foundation-,------------------Material------------------------------------------------- A ZF�e,,17-lAo"6- No. of compartments--------------------------Size-------- ------------------:----Liquid depth_-------------------------Capacity----------------------- Disposalield: Distance from.nearest well-----------------Distance from foundation--------------------Distance to nearest lot line__________--.___ �y. /AIZ Number of lines------------------------ ------.Length of each ------------------------Width of trench-------------.-------------------- Type bf`filter Depth of filter material--------------------------Total length---------------------------------------- . Seepage Pit:' Distance to nearest weil_11_7� •__Distance from founclation___,-.10._ _....Distance to nearest lot I--sne_��__._____. Number of pits-----/ --__._;____Lining material_ I_l�roko-__Size: Diameter--- �_v--------Depth------,Z�_ _____________ , Cesspool: Distance from nearest well-----------------Distance from foundation------_----_-------_Lining material------------------------------------- Capacity ❑ Size: Diameter----------------- --------------Depth------------------------------------------------------Li quid -----------------------_____gals Privy: Distance from nearest well__-a---------7 " Distance from nearest building____________________--_�.____._____ ❑ Distance to nearest lot line---------.______ .. ------ ---- I Remodeling and/or repairing (describe):------lajrele04-ewAml------ --a ------------------- = t -- ------------------- ------------- _ J----------------------------------------------- - ------------------------------------------------------------•------••---------------------------------------------------------------------------------------------------------------------------------------------------- . . • ------------------------------------------------------•---------------------------- i hereby certify that I have prepared this application and +hat the work.wll bedone,inA`accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed) 42 ---------------------------------------------------------(Owner and/or Contractor) .=a►�� +�- ------------------------------------------------------------- -- (rtle)_, _ _ '/ '''�`. -- '"c7�" ------- ----- I (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). IfOR DEPARTMENT USE ONLY ' APPLICATION ACCEPTED 8Y, -... ---=------------ ---------------------------- : DATE �.� —z --------- -- REVIEWED BY-------- ----- --------------------- -- ----------- - --------- - ------------------------------------------------------ DATE------------------ ----------------------------------- BUILDING ------------------ ------BU€LDING PERMIT ISSUED------------- --------------------------------------------------------------------------------------- DATE_---------------------------------------------------------- Alterations -and/or recommendations.`.--------- ----------•------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------11----------------------------- ------------------------------------------------------------------------- i � Y ----------------------------------------- Date ---. Date--------------FINAL INSPECTION BY: f SAN .. JOAQUIN LOCAL HEALTH DISTRICT f 130 Soufh American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California 'Lodi, California Manteca, California Tracy, California ES-9-2M 8-51 Revised W-2100 '`