2259 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No.1A---15.17 (Complete in Duplicate) ^ - Date Issued 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 County Ordinance No. 549. JOB ADDRESS AND LOCATION-------11"a-f- j-9 Owner's Name------------------•----------••--- �( ,> • ¢� �p--------------- � Phone_41ox-ve---------------- Address �Q kQ� ----Ss -------- /Ql7 '------------------ Contractor's Name __ 0,074----Z12P—' --------- Phone_-- ----- ---- ------- Installation will serve: Residence ®(. Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of'living units: Number of bedrooms __ __ r J�-. Number of baths ---it--Lot size Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe)( Hardpan ❑ Previous Application Made: Yes ❑ No K New Construction: -Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 fee+.) eptic_Lap k: Distance from nearest well.................Distance from foundation--------------------Material __.....-_-_..._...._-......___....___"...._"... LGM. No. of compartments--------------------------Size------------------------------..Liquid depth--------------------------Capacity----------------------- 0 Disposal Field: Distance from nearest wei) _._.Distance from foundatioa._,>�_� ..._Distance to nearest lot*11, eF_ --•---- l "' Number of lines-------- A(----. _ Length of each line__ DQ ._ __...Width of trench...._ Type of filter material__11,$._ k-_-Depth of filter ma terial___.jd... Total length_/QO-!"___"____""" • 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------------------------------------- Size:, .-.___-.___..--....._--__._ -�«•. w 3ze:-Diameter �' _` ""`M`_€3e squid Capacity------ ---------------------gals. r .,,.�.. _ate.,,• . p Privy: Distance from nearest well-------------------------------------------------Distance from nearest building___.....--_...._.___-.___-._.-------- Distance to nearest lot line.____....... ---- Rem lin and/ r repairing ( $tribe): -----------•-•--------------------------------------- -------------------------------------------------------------------------- I hereby certify that I h prepared this app cation and that the work will be done in accordance with San Joaquin County ordinances, Statelaws an es and r gulafionZOO?$, he San Jo in Local Health District. (Signd)--- e �r -_ ----------------„-'-'-�--------------- m,.{ r Confracforl y------------- .......M_„ -------- --- ---------------------------- ------------------ (Ti+le) -*g -r -ml"J<.� 1 ----- ------ of plan, s owl size of lot, location a system,in vela+ion to wells, buildings, etc., can be placed on reverse side). - FOR DEPARTMENT USE ONLY - APPLICATION ACCEPTED BY----------------------------------------- - -- DATE- ------- ---_-- . 2_ - ----------------- - REVIEWED BY - - DATE------------ BUILDING PERMIT ISSUED---------------------------- ------------------ --= DATE__-_------ '._ ---------------------------------------- - -A------- ------ --t----- Alterefions and/or recornm ati s:_ �r_.__. -------_--------- ---------- ----------------------------------------- 'z+•L. - - __ ------- - - 0- -� --------------------------------------------------------------------------------------------------------------------------- --- ---------- ---------------------------- n ----------------------------------------- ------------------------------------ ------------------------------------------------------- FINAL INSPECTION BY: -----------------------------------------------------` Date SAN JOAQUIN LOCAL HEALTH DISTRICT i 130 South American S+reef 300 West Oak S+reef 132 Sycamore Street 814 North "C” Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 8-51 Revised W-2100