8949 - Laserfiche WebLink

Home Browse Search

l� a. qc� qq APPLICATION FOR SANITATION PERMIT Permit No. .__r_.f_�/-.. (Complete in Duplicate) ��/. Date Issued ---__ ____ _/_�..-� 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 AN OCATION ----•----IV-C)---- .8--�d-ea-v_.------6i*-1----c- Owner's Name--------KPI ---------- --- --------------------------------------------------------------- Phone------------------------------------ Address-----------. o--- Contractor's Name.--------- 1 .+-.------4-4------ -----" ------------------------------------------------------ Phone----------------------------------- Installation will serve: Residence ❑ Apartment House 5�[_Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ a Number of livingunits: _ _ N umber of bedrooms _._ Number of baths _*n-Cot size -_____ ____- _ l 1/N > '± Water Supply: Public system ® Community system ❑ 'Private ❑ Depth to Water Table ./P-6 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe„ Hardpan ❑ Previous Application Made: .Yes ❑ No K—New Construction: Yes be_ No E] TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: . Distance 'from nearest well_ -Distance from foundation--------------------Material---_____________________________.---_--..____--. ❑ 2 f� . of compartments------- ------------------Size------------------------•-------Liquid depth---------- ---------- ---Capacity-----------•----------- Disposal Field: Ilisfance from nearest well----------__*-.-Distance from foundation______--____.__._._Distance to nearest lot line_________________ ❑ "umber of lines------------------------------t--Length of each line------------------------------Width of trench----------------------------------- Ty of filter material-------------------------Depth of filter material-----.-----------------Total length------------ _•-------------- r Seepage Pit: Distance to nearest well. -A/0from foundation__ 1 _-___�D stance to nearest lot line-____ - I�umber of its._ ._. ._ _ .__ _ Linin materiai__._e-0 C kize: Diameter__. ,, e to-_. ,� .�_.__ P 9 = p = Cesspool: Distanceji-om nearest well-----------------Distance from foundation--------------------Lining material ___-.._.-_-_..._---_---_________.___. \ ❑ Size: Diameter--- --------------------- ------------Depth------------------------------------------=---------Liquid Capacity----------------------------gals. Priv Distance from nearest well_____________________________ ____Distance from nearesf building g------------ ---------------------------- ❑ Distance to nearest lot-line----------------------------------------------------.------- Remodeling and/or repairing (describe):--------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------ r ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------- --------------------- -----------------------------------•---------------------------------------------------------------------------------•---------•--------------------------------------------- -- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State , s, and rules and regulations of the San Joaquin Local Health District. (Signed)------- --� -� �/Y�� ----•------------ ----- -------- ------------------------- (Owne and/or Contractor) gy —— -___ = (Title} ....................... -- - --------- ----- (Plot plan, showing size of lot, location of system in relation to wells,bui dings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- -------------- - ------ - - - --- ---------------------------------------------------- DATE---. ----------------- --------------------------------- REVIEWEDBY----- ------------------------------------------- ------------ ------------------------------------------ DATE BUILDING PERMIT ISSUED - DATE..------- -- —------ --- --------------------- C, -- ------------ - - --------------------------- --------•- Alterations and/ r commendations:.___f --_--.-_ __ ___ ------------- --------------------------------------------------------------- -- i FINAL INSPECTION BY:---- - ------ Date-2=Ci_ Es' r . --------=------ ---------------- 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 145446 ATWOoo 12-54 r