9649 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR 5ANITATIG,s,PERMIT Permit No. ._.-!_ _�.Y (Complete in Duplicate) Date Issued -....-- Applica*ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This a lication is mad e'in compliance with County Ordinance No. 54.9. Y, JOB ADDRESAND LOCATION___ _______ _____ �Y' 1 --- -- ----- ---------- ----------------------•------------ Owner's Name----Q?_g llj�--•------------`-31-- O.S'........................ ° /------ Address__.... 7.o�-----� -X---�� ...............................D /�. .0..<?------------------------- Contractor's Name---- ---�?-�'--'-- �-<:!o_---------------- Phon 4_�c VK-o I r R�3�Tr C Installation will serve: Residence E] Apartment House E] Commercial ❑ Trailer Court ❑ Motel ❑ Of�er I�-� J Number of living units: ______:_ Number of bedrooms __ ',__ Number of baths ________ Lot size _______________ -______________- 5 �- - Water Supply: Publi4' system'❑"Community system E) Private ® Depth to Water Table .a�.__. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel p Sandy Loam ❑ Clay Loam ❑ Clay ❑ A._e6be-P Hardpan ❑ j Previous Application Made: Yes ❑ No 0 New Construction:'Yes)] No ❑ / a TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank Distance from nearestwell ___'__Distance from foundafion--.'1'6./.-"--.Maferial-1(4� - 41P © No. of compartments------------------------Size.Z`.3 --------•------Liquid depth__.47__ _ ±- ---------Capacity--- ------- Disposal Field: Distance from nearest well___-1_9b..fDistance from foundation_____?__________".Distance to nearest lot line"________________ Number of lines {Len th of each line- -, -- _Width of 14 Number ------- g Type of filter material _"_:_ft" /__Depth of filter material____/,L' Total length_r�`P__ ___________________________ -.+... 4-.-�-..., ,. f�'D Seepage Pit: :. Distance to .ne-arest well--------------_-------Distance from foundation__.............._"_.Distance to nearest lot line.__________-_____ E] Number of pits----------------------Lining material-----------------------Size: Diameter------------------------Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation---------------------Lining material-_-.----____"_-"-____._____________- ❑ Size: Diameter- --� ------- =Qepth------- ------------------------------ -------------Liquid Capacity----------------------------gals. Privy:: Distancer rom nearest well --_-,--_ -- -. ------Distance from nearest buildin ------------------------------------------ DY Distance to newest lot line_____._._ Remodelingand/or repairing (describe):------------------------ -------------------------------------------- -----------------------------------------------•---------•------------------------ ----------------------------------------------------------------------------------- _.."-____""_"_-_---.-."_"---_"""_--"_.."_"-----------------""""_«_"--"-----."____""____-_--------_.--"•-".__.-----.---.-__--"_____-___"___- .._.-------------------------------------------------------------------- ------------------------------------ I 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. (Signed)-. ______________ - Owner and/or Contractor) Bir - --------•----- -------------------------------------- ---------------------•(Title}-. �s+� �' e --f'---------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reve ). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- ----- ------- --------------•------------------------------- DATE---3--Z7- 1-d------------------------ REVIEWEDBY--------------------------------------------------------------------------------------------------------------------------- DATE----------------------•---- - --------------------------- BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------------------------------------------ Alterations and/or recommendations: }--------------------------------------------------------------=------------------------------------------------ ------------- --------- z .......................................................---------'----------................................................---------------------------------------------------------------•---.----. ----•---------------__.. --------•----------- ---- ----- ---- FINAL-,INSPECTION BY - --------- ----- ------------- Date'- ---_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 t �S --2M ^ Revised-.,W-2100 u