3362 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. 1 -2 (Complete in Duplicate) Date Issued ------ --�b/S� 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. A0 -------------------------------------- JOB ADDRESS AND LOCATION-------- ---------- ------ Phone------------------------------------ v va&t/ , --- - --- ---------------- ---- -------------------- Owner's Name------- A4- __'--------I-------- -- Address------------------e...........-------------------------- --------------------------------------------------- Contractor's Name------------------------------------------------------------------------------ ------------------ -------------------------------------- ---- Phone--------------- ------------------ Installation will serve: Residence 0Apartment House El Commercial [] Trailer Court 0 Motel El Other []11y.4-11 — --------------------- Number of living units: J---- Number of bedrooms -3--- Num baths -./... Lot size IA-dx--- Water Supply: Public system El Community system 0 Private Number to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand C] Gravel R Sandy Loam El Clay Loam E] Clay ❑ Adobe Hardpan El Previous Application Made: Yes El No Wo' New Construction: Yes &jKNo El TYPE OF INSTALLATION AND SPECIFICATIONS: 00 feet.) (No septic tank or cesspool permitted if public sewer is available within i! Septic Tank: Distance from nearest well---5V --.__Distance from fourjL[ation----- No. of compartments--------- ---Liquid clepth------4"--"�P- Capacity------g P-P-0- -- -------- 01 ./ '.5 "o- 9 ion---/4?_'_P---__Disfance to nearest lot line----- -_ - Disposal Field: Distance from nearest well...4�P----Distance from foundat -- --Z;4dl- --------- Id'x 74� -----Length of each line-----------—__:-------------Width of trench-------- ------------ Number of lines---------- -- - ------ Type of filter material--- -i_?,;;,Awepfh of filter material---------/ -------Total length______________1A?__1L-------------- Seepage Pit: Distance to nearest well-----------------------Distance from foundation____________________Distance to nearest lot line----------------- El Number of pits-I--------------------Lining material-----------------------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----------------------------------------- 0 Distance to nearest lot line------------------------------------- --------- ----------------------I----------------------------- -------------- ------------------- Remodeling and/or repairing (describe):-------------- -------------------------------------------------------------------------------------------------------- ----------------I----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------I-------------------------------------------------------------------------I-------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------ ---------------------------------------------------------------------------------------------------------I-------------------------- -------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Count y ordinances, S ate laws, and rules and regulations of the San Joaquin Local Health District. -------(Owner and/or Contractor) �(Signed)- 11-344._60vw, - - -- ------------------------------------------------------------------------------ B ----------------------------Title ------------------------------------------- -------------------- (plot pl� (Signed}_ size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY DATE------------ --------------------- APPLICATION ACCEPTED BY------------------------------_2 (1)4 ------- REVIEWED BY------------------ -- -----•-- - ----------------------- ---------------------------------------- --------------------------- DATE---------------------------------------------------------- BUILDING PERMIT ISSUED------------ ----------- -------- -------- DATE------ ----------e-_-------------------------------------- /-S- �;CP _.� kq_', C� -------------------- k------�-o------------------------- --------------- Alterations and/or recommendations:_ fi� ------ --------------- --------------------------- ---------it ------ --------------------------- ------------------ --- i - ------ -------- ------------------------ .- -_I ------Is ------- -- -__-I_ -_�' -----------I --------------------- --------- ------- ZZ:LL�� ----------------- --------------- ---------------- ---------- ------------------------ --------------------- ----- --------------------I--------:j�--------5-3----------------S-e-e-wx ------- --------------------------- ------------------------------------------------- --------------------------------------------- ------------------------ ---- - Date.--------- ---------------- ------------------------------ FINAL I----------------------------FINAL INSPECTION BY:------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 132 S 130 South American Street no West Oak Street ycamore Street 014 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 10-52 Revised W-2100