5926 - Laserfiche WebLink

Home Browse Search

- I 17 t,+ u; } V, APPLICATION FOR SANITATION PERMITPermit No. ..--- __ ........ (Complete in Duplicate] 5 Date issued ---•------ ------------ Applica*ion isherey'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. �Q JOB ADDRESS AND LOCATION - _ U J�Lc ------------- `"' Owner's Name ------ ----------------- ---------------- Phone-----•---------- 4.0 Address__... _9 e -- ------U Contractor's Name -------------- ------------ -----------------•--------------- Phone--------•------ Installation will serve: Residence Apartment House ❑ Commercial E] Trailer Court E] Mote ❑ Other]Z r Number of living units: ________ Number of bedrooms -------- Number of baths -----.-- Lot size U *� ---- ------------ Water Supply: Public system ❑ Community system E] Private D< Depth to Water Table -I5— I __ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobel Hardpan ❑ Previous Application Made: Yes 0 No k New Construction: Yes A 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-wells%90_4— Dista ce from foundation__.__ ___W_.MateriaL..___.__ -t-49111 1 - _ [ No. of compartments_.___- l__.____-...._size_ .X1_�__Ai� __ _.___Liquid depth__-----T- __.__._Capacity_____s_�o(�_ Disposal Field: Distance from nearest'well_JOD__.-Distance from foundation_____ �9__-_.--Distance to nearest lot Ian - Number of lines-_---- -- ------Length of each line----------IS-10--------.Width of trench-------- ---------------- K Typo of filter material__5`�__________------Depth of filter material__.. -___________Total length------5_dq.__ - --------------•---- Seepage it: Distance to nearest well----------------------Distance from foundation-------------------Distance to nearest lot line------------------ ElNumber of pits-------------------,Lining material-----------------------Size: Diameter-----------------------Depth-------------------- ----------- Cesspool: Distance from nearest well-----------------Distance from foundation__-------_---------Lining material------------------------------------- 5 Size: Diameter_____ _________ Depth Liquir� Capacity gals. Privy: Distance from nearest well----------__-------------------------------------Distance from nearest building_____._______._____---________ ❑ Distance to nearest lot line- Remodeling and/orrepairin (describe):__. t f � � 6 �� /{1 ---- � - -- 7- - ------- --------- ------------- •-------------------------------------- •------------------------------ -------------------------------------------------------------------------- ----- -----------------•------------------------------------------------------------------------------------------------------- ------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinanceySfaff 'Paws, and rules and regulations of the San Joaquin Local Health District. (Signed)7 _ .f - (Owner O 1 ;' � [ r and/or Contractor] By:---------------------;----------------------------:---------•----------------------------------------------------------------------(Title)----------------------------------------------------------- - l [Plot 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-------------------------------- DATE -------------------- - C REVIEWEDBY `--------------------------------------- - --- --- -------------------------------------------- DATE------ --aQ----------------------------- BUILDING PERMIT ISSUED. ------ DATE Alterations and/or recommendations-------------------------- -------------------------------------------- --------------------------------------------------------------- ------ ----------------------------------------------------------------•----------••--------•------------- ---------------------------•------_- ------------------------------- FINAL INSPECTION BY-------------------- -------------------------'---------------- Date-----: 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 ES-9-2M Revised W-2100