6757 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) /% S� Date Issued ------------- -------- Applica+ion is hereby made to the San boaquin 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. f # . s JOB ADDRESS AND CATION ------------J. -c ----- 5�-{-v; -- -------- Phone------------------------------------ 4 i Owner's Name �° '�� ___' . - - --------- Address - 414 Contractor's Name ._.A --- --:---- --------------- ---------- --- -- Installation will serve: Residence Apartment House E] Commercial El Trailer Court E] Motel El Other El Number of living units: _/-___ Number of bedrooms :-_'2---Number of baths .__J_ Lot-size -__.-- -----___----_-_-_-------------- -- ----------- 1a o Water Supply: Public system ❑" Community system'❑ 'Private ❑ Depth to Water Table';50ft' Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[)a- Hardpan ❑ Previous Application Made Yes ❑ No & New Construction: Yes ❑ No a TYPE.OF INSTALLATION,1AN6 SPECIFICATIONS: 1 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Fes' _._ ..w. Septic Tan i tVo. , from nearest well------_----------- Distance from foundation__,__.__...--------.Material--------------------------------------_-_--_____. ❑ � mpartments--- Size-------------------------------Liquid depth--------------------------Capacity------------? ---------- Disposal Fi m nearost we!I_________________.Distance from foundation_-----___---_--__-_.Distance to nearest lot line------}__-------- ' ( l of,lines---- -----------------------------Length of each line-------•--------------------:.Width of trench-----------------------•---------- J ❑: m yp r filter material------------------------'Depth of filfer nnaf_er _, -----------?_-`Total, length--------------------.--------------------- Num e T 'e q Seepage Pit: Distance to nearest well____!ykt.Q -Dista e from fo ndatio :-.. _ _.':.=_:Di n e tp nearest'lot ii e___^_�______.. S a� Numb r of pits------- ------------Lining mater al , f"------ '� lam er - Depth i�. t R ' Cesspool: Distance from nearest well------------------Distance n--------------------Lining material----_---___---------_-_--_-_-__-----. Size: 6ameter--------i-----`----------- -----------Depth ------- -- E Liquid Capacity gals. Privy: Distance from nearest well-_ - _____-------------:_- 's._Distance from nearest building__________________________________:_._. Distance-fo nearest-lot'line._.___�'---"--------- " `" ❑ �., Remodeling and/or repairing (describe):---------------------------------------------------------------------------------' F `--------- f E !-- -- •-•--- ------------------------------------•------•-------------------------------------------------------- �. f f IIA. # ' - -- I hereby cert' -+ITaj I have prepared-this application and that the work will be done in accordance with San Joaquin County , . d rules and.regulations of the Sao Joaquin Local"Health District. ,t 5s ned__-- . .._--- p r I 7 ordinances, t e aws„an ' (Signe ) - - ---- ---�-- �-�---�-------'-- '-----------r-- --------------------------- -- -(Ow rand/or Contractor] -, = n ----------------(Tile)------= -------------- ----------------- (Plot plan, showing size ofIot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY--------------------------------- -- '------------------------------------------------------ DATE-----J--------'---- - •---------------------------- REVIEWED -----i - ---REVIEWED BY._ =' :. �_..: ---:-- DATE ---------------------------------------- : ...._. ------------------- ......PERMIT ISSUED-------------------- ------ -- ------------------------------------•------------ DATE-- ----- Alterations and/or recommendations----=-------------= --- -- -------------•------------------------------------- •--•- ---------------- ---�! ----------------- i : -_----------•-•---•-•--------------------- ------------•--- - ` ' --------°------ ------------------- ---------------=-------------------------•--------------- 'M f --------- - •- --------- -------------------------------------- --------------- Date - --- -- V _ --------•----- Date-.._ ---FINAL INSPECTION BY:.__ -� " SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Stree300 West Oak Street 132 Sycamore Street 814 North "C” Street Stockton, California Lodi, California Manteca, California Tracy, California �.,,:� ES-9--2M Revised W-,2100