2720 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. ------------- (Complete in Duplicate) I Date Issued ___ '_ Application is hereby made to the San Joaquin Local Heolth District for a permit to construct and install the work herein described. This application is made in compliance with County Or mance No, 549. JOB ADDRESS A D L0(?ATI _- --- -•---- a Owner's Name---- F ' ---•--------------- - - ---- =� 1 i: ----------------- Phone- nom V Address------------ j ' ----- '. 1 Contractor's Name------ ------- ------ -- = ') -------------------------------- Phone ---------------------------------- - - Phone- Installation will will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motu. ❑ Other,❑ # Number of living units: _��Community umber of bedrooms Number• of baths%3____ Lot size -- Water Supply: Public system system ❑ Private ❑' Depth to Water Table -------- ft. h Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [] Clay Loam ❑ Clay ❑ AdobeHardpan ❑ Previous Applicafion Made: Yes ❑ No e Now Construction: YesE�r ollNo ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: _AKF _ (No septic tank or cesspool permitted if public sewer is-available within 200 feet.) 401 _VA Septic Tank: Distance from nearest well_________________Distance froml foundation------------_-------Material _______-_-____________--______________ c .' ❑ No. of compartments--------------------------Size---------------- 1--------------Liquid depth--------------------------Capacity------------------- �l Disposal Field: Distance from nearest well_______________ Distance from'�foundation--------------------Distance to nearest lot line_____.______.-__. ❑ Number of lines-----------------------------------Length of each line-----------------------------Width of trench i Type of filter material--------------------- ---Depth of filter'; material-------------------,---Total length------------------------------------- --- Seepage Pit: Distance to nearest well----------------------Distance from 4oundation--------------------Distance to nearest lot line___--______._____ ❑ Number ofits_____________ ____Lini P g /material--------------�--------Size: Dia ler-----------------------.Depth ------------ Cesspo ;. Distance from ne r t yve _ _- -: Distance fro 'foundatiori4Z' __�___ g 74 �[i0jj Linin material " Size: Diameter Depth- .�_ _Liquid Capacity "U gals. r T� Privy: Distance from nearest well--------------- -----------------------------' ______Disfiance from nearest buiidin g----------------•----- ------------------ El Distance to nearest lot line________________________ - - - - ---- ------------------ -- --- 846 odeling aPd/or repairing (describe , ` --- - -------------- --•---------- •-•--------•-----•-•----------------- -•-------------•-......••..----- r ----------------- ---------------------•------------------- I hereby certify that I havrepared this application and that the:work will be done in accordance with San Joaquin County ordinances, State laws and cures and regulations of the San Joaquin Local Health District. '------ ----------------------------------------------- ----------------(Owner and/or Contractor) Y:' --------- -----------------• -------------------------------------- --- ------'�---------------- Tale /. (Title) ------------- ot plan, 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-(?---------------------------- --------------------------------------------------------I---- DATE-=-Z& i REVIEWED BY------------------------------ -------------- ------------------ ---------------------------------------- DATE--�. --------•---- l BUILDING PERMIT ISSUED----------- ;' ------------------- ---------------- -I --•---------- -------- DATE-----�_---------------------------------------------- ---------------------- - ------------------- -----------------------Aterations and/or recommend stions:____________-___.______ -----------------------------E: ------------------------•----------------- - l------------- -------------------------------------------------------------- ---------------------------------------------------------5 ------------------------------------------------I---------------------------------------------- ------------------------------------------------------------------------------------- ------------------------------------ -------------•-------------- ---------------- --------------------------------------------------------------- ----------------------------------------- ------------------ - ---- ------------- ------ -------- -------------------------------------- ----------------------------------------------- FINAL INSPECTION BY: Date--- ------------ _ -- ----------------------------------------------- SAN ------- ----------------SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street F132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California ;Manteca, California Tracy, California ES-9----2M 8.51 Revised W-2100 A