4242 - Laserfiche WebLink

Home Browse Search

,�,►.�-� � APPLICATION, FOR SANITATION PERMIT Permit �{ (Complete in Duplicate}o _ Date Issued -7=-s3 . Applicati Is hereby made to the San Joaquin,Local:Health,District,for a permit to construct and install the work herein described. - l This application is made in compliance with County Ordinance No. 549. , • JOB ADDRESS AND LOCATION-___ ' _ - �---- ----- .--- Owner s Name --- -- - -------------- hone :7 1 i -� r -... ----------------------- ---- -------- ------------------------- Contractor's Address---------------------------------=------------------- ---- -- -------- Name----------------------- �"L► 1 - '.--- _--------------- --=------------------ t Phone f .�. y, Installation will serve: Residence [a Apartment House I] Commercial ❑ Trailer Court ❑ Notel ❑ Other ❑ Number,.of living units: _ -Number of bedrooms ___..7-- uri'ber of 'baths .. __. Lot size ______________ ��a_ _=___ _ r__-___-_--- Water Supply:' Public system ❑ Community""system`❑""Private�.,K-7Depth to Water Table:_"_ :.ft rs Character of soil to a depth of 3-feet: Sand ❑. Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay.❑ Adobe�t�rdpan ❑ Previous Application Made: Yes ❑ No5L New Construction: Yeo ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.)' �M t i I IE Septic Tank: Distance from nearest well��f':'_Distanice from found i I *a er a _ __�__�-� -------- No. -- --No. 'of compartments....... -----------Size____, . -1 _ Liquid clepth--- Capacity.. ' Number of lines_____________ ______ - Length of each line__::____ ��/� Distance to.nearest lot line_____ r r Ci Dis osal Field: Distance from nearest �E!_- _ Distance from foundation r �r p fJ g -�---.Width of trench.-•-•- ----- _, = Type of filter material____ . __._--___-_-_Depth of filter material_-_-.- -- Total length_____ __ �2__--_ __ ____. Seepage Pit: Distance to nearest well:.__________ ______Distance from foundation_---------------------Distance to nearest lot line__- _____-_:� ❑ Number of pits_______ ---------------Lining material_____ Size: Diameter '--,Depth-De tn- r_ rir a,.-G ---�-.:.,...-r -=s---=--� ., �J. -.r=—'---.------�------'-y ,.Qesspool;, ,.'i 4.. Distance,fi;om nearest well__- -_ -_Distance from foundation_________ _______ Lining mbterial------------------------------------ __S ize: ______-_ ___ ----_________3Size: IJiameter _ Depth--_-- x Liquid Capacity-----------------------------galsi Privy: i ----------------------------- ---=--- ------------------------- Distance from nearest building-------•_-- - -- Priv Distance from nearest well____________ - y � ❑ Distance to nearest lot line_______________ ------------------------------------ -- -------- ------------ -- --------- •------ -- Remodeling and/6r repairing (describe----------- ---------- - ---------- - ------------------------------------ ---- ----------� :-------------------------------------- W -------------------------------- -------------------------------------------------•------------ ------------------------------------------------------•---------- --------••--------- -------------•----------------------------------------------------•----- •---•------------------- 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)- = y �-�{x-txw.;+..• =-----------------=--------------------------------(Owner and/or Contractor( (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---------------------------- rDATE - - REVIEWEDBY------------------------------------------ --------------------------"----------------------------------------------------- DATE------------ BUILDING PERMIT ISSUED---------------------------------------------------------------- = = ---------- DATE--- -------------------------------------------- Alterations and/or recommendations:-------•----------•------ --------- - ----'=----•------------------------------------------------------------------•-•------•----------------------------- . --------------------------------------------------------_------------------------------------_------------____________------------------------------------_------------------------------------------------------------- ------------------------------------------------------------------ ----------------------------------------_--------_------------------------ ------------------ ___----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------.--_-______--.--._____ FINAL INSPECTION BY:.-----G``w '---- --------------- = Date-----`-------- -----------------•---------------- SAN`JOAQUIN LOCAL HEALTH DISTRICT 130 South American Stree+ 300 West Oak Siroet 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES---9•--2M 10-52 Revised W-2100 ' -!