3490 - Laserfiche WebLink

Home Browse Search

3r�1 �PP �ICAIIDN FOR SANITATION PERMIT Permit No. ........................ (Complete in Duplicate) Date Issued ------------------- Application -------.._-------- A lication is hereby made to the San Joaquin Local Health District for permit to construct and install the work herein described. pP Y q p e This application is made in compliance with County Ordinance No. 549. : qq JOB ADDRESS AND LOCATION--------2-0- /--------- Owner's Name------------------------- � U�=-------------- �•._h G f�---------- --- ------------------------------------------.. ------ Phone------------------------------------ Addressa 7 �.. lQ•. '-. _......_..--•----------------•-•---- Contractor's Name----------------------- ----- Phone------.--------.---.- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _/____ Number of bedrooms Number of baths -4___- Lot size -------- --- -- --- k /S_S'"� --- ------------------------------- s Water Supply: Public system `Community system E] Private ❑ Depth to Water Table ________ ft. Character of sail to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe gq' Hardpan ❑ Previous Application Made: Yes ❑ No 9_ 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----/0_i_______.Material___________________________________.._.--------- No. of compartments--------Y_---------Size----.rX -----Liquid depth---------- -Q------Capacity------epb!p...... Dis osal Field: Distance from nearest well---..__—__.._Distance from foundation_____ZIP.......Distance to nearest lot line----5------- Number of lines-----------------/.----------------Length of each line-------------/P5)--------width of french----------�_._`L— ------------- � Type of filter material-------------------------Depth of filter material-----------------------Total length-------.-------/d_0---------------- 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-________________Distance from foundation--------------------Lining material--------------------------------------V* ❑ Size: Diameter-------------------=-----------------Depth----------•---------•-------------------------------Liquid Capacity- --------------------------gals. Privy: Distance from nearest well-------------------------------------------------- from nearest building--------- ---_____________________________ ❑ ' Distance to nearest lot line----------------------------------------------------------------------- ------------------------- ------------------------------------------- Remodeling and/or repairing Idescribe):------------------------------------------------•--•----------------------------------------•-- -----------------------------------*------------------• a ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ c -------------------------------------------------------------------------------------------------------------•-------.-----.-------------------.'---------------------------------------------------------------------------- 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).!''-" r------- ------- -- ---------------------------------------- -- ---------------------(Owner and/or Contractor) By:------------------------ -----------------------(Title)--------------------------------------------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). 1 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------------------ __ DATE____-________ _ ' -------------------------------------- --------- 2 i_�- I REVIEWED BY-------------------------------------------------------- -- ----------------------------------------------- DATE-------------------•---------------------------------------- BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE----------------------------------------------------------- Alterations and/or recommendations:------------ -----••-------•---------------•--------------•--------------------- .---------•---- -----•----------------------- ---------•--•---- w -----•------------------------ -------- ------------ .1+ g- ----------------------- - ------------ ------ _ y - _._ �� "!-_�C.7'P-C-r_� r--- --u----'� 1'"�.�---'�'----- ��..�.-'��--- - --- C'U��-x�+/.-�.-- �i_� =-- FINAL INSPECTIONBY: Date.-------�://. ------------------------------- k SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, d1ifornia Lodi, California Manteca, California Tracy, California I 1 ES-9-2M 10-52 Revised W-2100