6709 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit' No. .__�F_� __ (Complete in Duplicate) pate Issued --- _74:74 Applica+ion 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 ADDRESS AND LOCATION-----------------15---- ----.No,-------o'.l.I_Y_tjLIC--------------------------------- I------ ------ - -------------------------- Owner's ---- ---------------------Owner's Name---------------------------------------- - sT------------�A-f G--=-------------------- ------ Phone------- -------- Address—...... -------Address---------T ------------- ---------------------------------------------------------------------------------------------------------------------------------- Contractor's Name------------------------------------------------(S-401c)------------------------------------------------------------------------- Phone----------------------------------- Installation will serve: Residence Rf Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ i Number of living units: ________ Number of bedrooms ._;L__ Number of baths ________ Lot size ----------------73-- f__1.2. -_-_____-______ Water Supply: Public system X Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe,f Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) C.A llJJ Septic Tank: Distance from nearest well-----�Y0______Distance from foundation-----1!k----------Material---------- __________________ p Z x.�_X Liquid depth----------Y> --Capacity----- - No, of compartmentsSize._.-ti _____ g��-- �f� Disposal Field: Distance from nearest well._.._Na-----Distance from foundation-------?D _____.Distance to nearest lot K Number of lines-__-________._._.3_.._ Length of each line__Sv_-3_$755------Width of french._____._____4y�__.____.____ Type of filter material--------j_7j __ ___Depth of filter material_______f_V"'____Total length______________ _____�!_e ___ ac See e Pit: Distance to nearest well__________________ ___Distance from foundation to nearest lot line______-_-_____ Seepage ❑ Number of pits----------------------Lining material-----------------------Size: Diameter.--- -----Dept h-----------------------------.- Cesspool: Distance from nearest well------------------Distance from foundation-__r_,._-_-------,.Lining material____________________________________. ❑ Size: Diameter---.--------------------- ---------- Depth-.---------------------- •----------------------Liquid Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ ElDistance to nearest lot line--------------------------------------------------------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe)---------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------- , ------------ ------------------••--------•-----------------------•----------------------------------•--------------------------------.--•----.............----------------------------------------•--------------------------- --------------------------------------•---•----•---------------------------------------..........---------------------------------------------..------------------•---------------.----------------------------------------- I hereby certify that I have prepared this application and Aa-t 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)---------------_------------------------------ ------------------------------------ -------------------------------------------- -------------------------- Owner and/or Contractor ---------------------------------------••----------------------------------{Title)-------------------------------------------- - ---------------- (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------------? -rte � ,-- ----- �<,! REVIEWED BY-------------------------------------------------------------------------------- ----------------------------------- DATE---------------------------- ------------------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------------------------------------------- Alterations and/or recommendations:------- ------------------------------------------------------------...._.-------- ----------------••--------_-.--•---------.-------------•-------------------- ---------- ----------------------------------------------------------------------------------------------•--•----------------------------........-------------------------------------------------------------------------- --------------------------------------------------------------------------------- -----------------------------------------------------------------------------------------•------------------ ----------------------------•---------------------------------------•----------------------------------- FINAL INSPECTION $Y:. � �------------------------------------ Date - �1. ' SAN JOAQUIN LOCAL HEALTH DISTRICT. 130 South American Street 3Q0 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Mantaca, California Tracy, California ES-9-2M Revised W-2100