4363 - Laserfiche WebLink

Home Browse Search

G .. � %,>�[ APPLICATION FOR SANITATION PERMIT Permit No. ._____ _ !._ U" (Complete in Duplicate) 3 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 ADDRE=SS AND LOCATION___—.2�-1-0_---�1.iRN-��4�-�----�QA+�-----"�------`�� _ev---------------- ------ Owner's Name _'" + s Phone G�_..I_ -------- Address-------------------•--------------------------------q- I-a- ---------- �....-----------------------------------------------------•---•---------------•--- Contractor's Name-------------------------- ----------- rY.C- ---------------- Phone---- ------ Installafion'will serve: Residence 5. Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _f____ Number of bedrooms ._Number of baths l_____ Lot size ____--_-5 _------___ Water Supply: Public system ❑ Community system ❑ Private J& Depth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam❑ Clay Loam ❑ Clay ❑ Adobe;& Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ -L'ptL�p �- G � t TYPE OF INSTALLATION AND SPECIFICATIONS: F I (No septic tank or cesspool permitted if public sewer is available within 200 feet.) °tic -ailk,. Distance from nearest well-----------------Distance from foundation--------------------Material_________________________________________________ 12 '"'T No. of compartments-- -----------------------Size--------------------------------Liquid depth--------------------------Capacity----------------------- osal ieldi Distance from nearest well" _�_._.Distance from foundation__,_l?_r ___...Distance to nearest lot line__ — W - ----------- 2p �""� Number of lines------ _`_ ____________Length of each line___ _a_ -L_. -__Width of trench._ �_' -------- --------------------- A�L Type or filter material.!_-].____-!_24-____Depth of filter material_________, _-__._Total length___-�p_'______.____ •- Seepage Pit: Distance to nearest wef!----------------------Distance from foundation--------------------Distance to nearest lot line-----_____.__..__ ❑ Number of pits----------------------Lining materia l--------------.-- -----Size: 'Diameter.------------.---------Depth---------------------------_----- Cesspool: Distance from nearest well____________.___Distance from foundation----------__--------Lining material------------------------------------- ❑ Size: Diameter------------------ -------------------Depth----------------•------•----- ---- ----------Liquid Capacity----------------------------gals. Privy- Distance from nearest well-------------------------------------------------Distance from nearest building___.________-___-_______:____ ❑ Distance to nearest lot line---------------------- ------ ------------------------------------------------ -----I------------------------------------------------------- k Remodelingand/or repairing (describe):----------------------------------------------------------------------------------------------- ------------------------------------ ------------------• • ----------------------------------------- -------------- ---------------------------------------------------------•------------------------------•----------------•-------•- ---------•------------------ --------•- ------------ - I here that I have prepared this application and that the work w II be done in accordance with San Joaquin County ordinances, State la s, an rules regulati ns of the San Joaquin Local H Ith District. (Signed)------ .- - - - --- ------- ---------- --------- - ------- ------- - ----------- _------------- Contractor) -- BY: ---------(Title) it-SM,--1v\-A -0' -"--------------- (Plot plan, showing size of lot, location of system in tion to wells, buildings, tc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- ------------ -- ------'---------------- --------------- DATE------- ---------a REVIEWEDBY--------------------------------------------- ------------------ ------------------------------------------------------------ DATE--- ------ --- ---------------------------------------- BUILDINGPERMIT 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 10-52 Revised W-2100 s ' .