6071 - Laserfiche WebLink

Home Browse Search

i A APPLICATION FOR SANITATION PERMIT i\tNVJ-- (Completelete in Duplicate) �,� Date Issued .--l-7•_________------ Applica4ion 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---------• --Z 3 `S a Owner's Name------141— 1------P10' Q i Address---------------,_r�--3-------'-----------' Q. D , Contractor's Name--•----{.�_--! : �� -------- ------------------ --------------------•----•-------------•--- Phone- 11' Installation will serve: Residence-N Aipartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --I---- Number of bedrooms -,3--- Number of baths __/__-_ Lot size --_6__6-----XJ-4-4-------------------------------- Water Supply: Public system,[V- 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 Hardpan ❑ Previous Application Made: -Yes ❑ NoW New Construction: Yes 99 No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I w Septic Tank: Distance from nearest well-_-___ _____ Distance from foundation-___1_l-------.Material----_ _:4 '__ - -------- 1XI Noof compartments------A---------------Size--- ..4__ --3__G.._..__:._.Liquid depth---------------------------Capacity------904_- Disposal Field: Distance;ifrom nearest well.---.-_---------Distance from foundation-------------------- Distance to nearest lot line-----_:--_--_---. Number of lines-----------------------------------Length of each line-------------------•----------Width of trench-----------------------.---__------ Type of fi er ateriaL__-___ . ___ Depth of-filter material---------------_--------Total length------------------------------------------ 14 K Seepage Pit: Di enc to nearest well-----_�----_-__--Distance from foun ation-:_- --Q-------._-,Dista��e to nearest lot line______ _________ Number`of its--------- ------ ----Lining material----S°c. -e-- fG ize: Diameter___.#_�_---------..Depth_..._rs� ---------------- [ p „„ Cesspool: Distance;;from nearest well--- -----------Distance from foundation-_-_-.---.---_-_--- Lining material_-____--.-.-_______---_--_---_-____ ❑ Size: Diameter---------------------------------------Depth----------------------------------------------------Liquid Capacity---------------------------gals. N Privy: Distance;from nearest well------------_--------------------------.---------Distance from nearest building-_.-__________---_-----_-----..--------- ❑ Distance`!to nearest lot line------=-- -------------------------------------••-------------. -------------------- ------------------------------------I-------------------- ---------------l------------•--••---------------------- ......------------------------------•---------`------ Remodeling and/or repairing (describeJ_____________'__-_____._______._________ --- _----------------•--•---------------------------------------------------•- ----------------- --------------- ---------•---•--------------------•-------------------------•----------•-•••-....--------------------•-•----------------------------------------------: 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)------- .19- pa I?1- 4------ ---------------------------•------- ----------------------(Owner and/or Contractor) $y:.... -------L------" E,_ _Ilk ----------• -•------------- ---(Title)------ e--------•------------------------------ (Plot plan, showing size of lot, location of system in relation to wells,,buildings, etc., can be placed on reverse side). !' p FOR DEPARTMENT USE ONLY APPLICATIONACCEPTEDSY- --'------ ------------------------------ ---------------------------------------- DATE.�------------------ ------------------------------- REVIEWED BY------ •-------------`' ------- --------------------------------------------------:,.---------------------- DATE-- RM qf BUILDING PERMIT ISSUED 1--------- DATE------------ ----------------------•--•-------------------•- Alteratians and/or recommendation = - H , .. ............................ w � a, ---------------------.--------.-_---.---.-__-..- ---------------_------------------------------_---------.-------------------.............. ------------------------------ ----------------------------------------------------- ------------w------------_.-. .. ___-----_._-_.--_..-_---.-._x .--_-_-._-_b-_..-_`-_--.5-._r.-b---�--- ..-----._------------_.------.._-- FINAL INSPECTION BY:rw ---- -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 y ES--9-2M Revised W-2100