5735 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. lt-� .... 10(Complete in Duplica+e) , Date Issued l/147. 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. 549. 3 JOB ADDRESS AND LOCATION-----IBly-------.5 -'a 47� Owner'Name 1 c h-a � 0 --------------------- . Phone- -- 3 Address..__aD G ------ P- a. - ... Contractor's Namevb- oa --------------------=---------------------- ----- ------------ Installation will serve: Residen'�ce House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: 02 1 D U fi21� Number of bedrooms -� ---- Number of baths -- _- Lot size ---`-��---- -�9------------- -----------------•- Water Supply: Public system CoVmmunity�system,❑_,Private,.❑_Depth•to-.aterTable ySft. Character of soil to a depth of.3 'feet:f Sand q]� Gravel ❑ Sandy Loam ED] Clay Loam ❑ Clay ❑ Adobe[R-Hardpan ❑ Previous Application Made: Yes [] No !New COnSUUCtiDn: Yes ❑ .No TYPE OF INSTALLATION AND SPECIFICATIONS:! k ! (No septic tank or cesspool. permitted if public sewer is availablewithin 200 feet.) Septic Tank: Distance from nearest well-------- ------Distance-from foundation - -.______------Materiaf--_--_-----_-_-___----__._---_-_--___-s--_.-.__. 10 No. of compartments---------t--------f- -Size--------------------------------Liq yid depth 33 --'-- --------------Capacity----------------------- ' ------------- -------- isposal Field: Distance from;nearest well_-- from foundation_____________ I __-_..-Distance to nearest lot line----------------- ❑ Number ofili nes-•----------------I------- !------Length of each line------------ ----- Width oftrench--------------------------------- I Type of fiiterxmateriaL_-_.I-------_i-__-__Depth of fi#ter material___(_.-.- �- --- ------Total length--------------------------------I--------- Seepage Pit: Distance to nearest well- 4"��------Distance from foundation-1--4 R_---_-..Distance to nearest lot line--- -_------_ Number of.pits----- -----------Lini g materials p !Ck$ize:�Dl ameier---- !--------Depth-------3p---------------- Ces Distance from nearest well--- --------_rDiltance from foundation. ....... ....... Lining material-------------------------------------. p ____-.Liquid Capacity- ❑ Size: Diameter----- k--------------i---------1Dep th P Y gals. Privy: Distance frim nearest well1 4 _____ __________ !- ---------Distance from nearest building- --------------- ❑ Distance to nearest%lot line`-A---- ------------------------------ * ; ," `= ------t------------------------------------------------- Remodeling ----=---------- -----------------------------Remodeling and/or,repairing (describe] - ---------- --------------------------------------• ------------------ fl --------- ------- ---------------------------------------------------- -------- ------------------------------------------------------------ =----------------•----------------------------- --------------------•---------------- I hereby certify that lth`ave p>epared�.this�app'lication and that +he work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed) �( O 1}DaL E- •S rV1 e �a �C a 9 ] -- --- ------ --- ---- ------ -- -- -------- ------- (Owner and/or Contractor] 8y:. ! j1 1 k/ ---------------------- -------------------------------------------------(Title)-----s2 1C -� `a (Plot plan, showing size of lot, locatioyof system in relation to wells, buildings, etc., can be placed on reverse side-1 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- ---------------------- ---------------------- DATE------ r REVIEWED $Y----------------------------------------------- ---------------- ------------�c.Si�-------------------------------- DATE------!- -_---�--•-�-- ------------••---------••--- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE-------------- Alterations and/or recommendations------------------------------------------------------------------------------------------------- -------•--------------------•-----------------------•-----•-----•----------- --------------------------------------------------------------...--- -------------•-------------------•------------------------------•-------- -----•----------------------- ----------------------- ---------------------------------------------------------------------------------------------=-----------------------------------------•------------------------------- ------------------------------ ---------------------------------------------------------•-------•--•--------- - ------------------------------- a _ � FWAL INSPECTION BY:`------------------- ----- ------------------------------ Date..- �--~-J-----------------` ~ 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 3 SES-9-2M Revised W-2100