989 - Laserfiche WebLink

Home Browse Search

ys M. ,. APPLICATION FOR SANITATION PERMIT Permit No. _:---d._ ; ......\ (Complete in Duplicate) Da - +e Issued __��_ ( t. t 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. �� ,,pp --- JOB ADDRESS AND LOCATION----------- ----t�--�-�---- ------�--------1.3"�j'---r v�4-------------------------------------------------------------- -- Owner's Name.- G-Cr.d �'-------- ----------- - Phone-------------------- I� Address-.----••------------------•-------------------32,A ---------�-�------- r �` Y'� I'" ` !_ -------------------------g------------- Contractor's Name-----------------•------------0 L��-r------------------ =------------------------------------------------------------- Phone___3 -_-r�-�C1_(------- Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer _v�_4P � _�� ----------------------- er Court F1Motel ElOther Number of living units: __!_____ umber of bedrooms _ -_ Number of baths _I-___ Lot size ________ ___ _/_ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table ________,ft. Character of soil to a depth of 3 feet: Sand Gravel E] Sandy Loam Clay Loam E] Clay E] Adobe Hardpan L]Previous Application Made: Yes E] No Sand Construction: Yes No ❑ 4 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic nk: Distance from nearest well____-__-''-.Dista e from f�dation.-___1__--------Matefial----}'e_ � _ ___CL _. co -t No, of compartments--------- ---------Size__—X 4:�-5----------Liquid depth_.___�__.________--Capacity____�----------aW Disposal Field: Distance from nearest well-------___________Disfance from foundation------/_iQ---_Distance to nearest lot line_,.5__r_ 1lt. Number of lines_-______ -- „-__ --r Length of each line.--�� Q�_�&_.Width of trench---------�--�-- ---------------� Type of filter material.__ ---i;l_c ____Depth of filter material__,__E__�_ � ___________Total length__-_.-__---1- ------------------ Seepage Pit: Distance to nearest well----------------------Distance from foundation___•----_.._______.Distance to nearest lot line_____________... ❑ Number of pits----------------------Lining material-----------.-----------Size: Diameter-----------------------Dept h--------------------.--._-------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material----------------------------...._____- ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity------'•--------------.-LL:=--9a1 s. Privy: Distance from nearest well ________________________ ____ _---------------Dif're from nearest building_------------------------------------------ El _____ _._______.._____._ ____._____.❑ Distance to nearest lot line---------------------------------------------------------------------------------------------------------------------------------- ----------- Remodeling and/or repairing (describe):-------------------------------- ------------------------------------------------------------------------------------- - ........ -•---•-------•------•------------------•-------------------•----------------;---------------------...------------------------------------------------------------------------------------------------------- -------------•----•--------------------------------------------.....----- ---•---------------------•----------•-------•-••-----•---------------------------------------------------------- ...._.................--------- ------------------ ------------------------------•------------------------------------•--------•--------•------------•- -•---•-------•---------------- ------------••------------------------------- 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)- 1_____---__ --------------Owner and/or Contractor ]/ -- - ------------------- By:... CS. - � - - �Ti+le}---------------------------------------------------------------- (Plot plan, showing size of lot, locationof�i/system in relation to wells, buildings, etc., can be placed on reverse side}. FOR DEPARTMENT USE ONLY APPLICATION,ACCEPTED BY--------------------- -- - ----------------- --------------------------------------------- DATE--------/ E ------------------------ REVIEWEDBY--r:m__------------------------------------- ----------------------------------- ----=------------------- ---- - ---- DATE--------------------------- BUILDING PERMIT ISSUED-------------------------------------------------------------- - _ DATE--.- ------- -- Alterations and/or recommendations:----------------------------------------------- --------•----------------------------------------------------------------•-------------------------------------- ---------------------------------------- ------ ---..----------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------I------------------------------------------------ FINAL INSPECTION BY: �i_ --------------------------------------------- Date-------- ---- -- ----------------------------------------- SAN -- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street S+ockton, California Lodi, California Manteca, California Tracy, California E5-9-2M 8-51 Revised W-2100