8268 - Laserfiche WebLink

Home Browse Search

APPLICATION POR SANITATION Permit No. .___f'--. --(0-�-• N PERMIT (Complete in Duplicate) Date Issued .____,_.�''� �G- 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 L C T'ION A ?�7c3ao ----------- Phone -- ----- s Name------------ ------Owner Address................ . ..... ... . Phone. Contractor's Name................................... --- - lnstallation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ 1 __._ Number of baths .___.___ tot size __ .____._ _ "_ ______ . --- Number of living units- _/--- Number of bedrooms Water Supply: Public system' �ommunity system ❑ Private ❑ Depth to Water Table #�t. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam El Clay ❑ Adobe[ ardpan E] Previous Application Made: Yes ❑ No O�New Construction: Yes ❑ No 2-' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.} Jerial___ae1---R Septic Tank: Distance 4rom nearest well istance from foundation__-"-� �.- --- --- ---Size_.56--�3�-��•---Liquid depth----�4---"---------Capacity---CD4-- No. of compartments_..__ . i Disposal Field: Distance'from nearest well�� Distance from foundation__- --------Distance to nearest lot line�_____ Number.of lines--------'�-:---. ---Length of each line--- 7l s;� Width of trench...... -------------- Type of:'filter material S. G ��-_Depth of filter material-_.!- ------ --7otal length.._____ ----•------ �pp ff�� / r,/ Seepage Pit: Distance to nearest well. .��`"'I----Distance from fo ndation____,4 �-"----Distance to nearest lot line_--`S_._________ (� _Linin material__-Size: Diameter_"_ '� . Depth. - ------------------- Z V' Number•of pits._._-----= ---- g -- Cesspool: Distance from nearest well-----------------Distance from foundation ing - --------- qmaterial Capacity-... ga--l-s-. ❑ Size: Diameter------- -------- ------- ------= Depth----------------------------- ---------- Privy: Distance from nearest well__-----------------------------------------------Distance from nearest building------------------------- - ❑ Distance to nearest lot ----------------;--------------- ---- - ---------------•---- -------------- ------------ 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, Sta a s, and rul and-regulations of the San Joaquin Local Health District. wrier and/or Contractor) (Signed)-- - � ------------ -------- - -------------- i - - � � -- - (Title--------- - -'----------•---------- Plot plan. showing size of lot, location of system in elation to we11s, buildings, etc., can be placed on reverse side): ( FOR DEPARTMENT USE ONLY ' I DATE ------------ APPLICATION ACCEPTED BY------- ------------------- -- -. . ---------------•------ REVIEWED BY. - ---- --- DATE DATE----- BUILDING PERMIT ISSUED-------•----------------------------- -;!� ----------------- -- Alterations and/or rqc mmendations,�------------- - ------- -- --•----• --------------------------- - ------ ------------------ --------------------------_ --------------• - - ----------- ........ Date FINAL INSPECTION BY:_. _ ---------------------------------------- ---------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 132 Sycamore Street 814 North "C" Street 134 South American Street 30D West Oak Street Y Trac California Stockton. California Lodi, California Manteca, California Y� E^ g—Zr4 145446 nrwoon 12-54