7498 - Laserfiche WebLink

Home Browse Search

�1 APPLICATION FOR SANITATION PERMIT Permit (Complete in Duplicate) JJ �j Date Issued3U-1,`� o,;,,,,- Zso-4 Z Applica+ion is hereby made to the San Joaquin Local Health District for a permit to construct and i�r st the work herein described. This application is made in compliance wit ounty Ordinance No JOB ADDRESS AND LOCATION__ - Owner's Name ' .. Phone Address__.---•----•------------ - Contractor's Name---- —7 -1y •-------- Phone/_�-..(� ----------------------------------------------- Installation will serve: Residence a-+ant House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms __Number of baths ___t-_-- Lot size ----- _Q-_--- ---� _, Water Supply: Public system 0--r:ommunify system ❑ Private ❑ Depth to Water Table X(7 Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ Previous Application Made: Yes ❑ No 171 New.Construction: Yes f4—#a`F 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 ,.cDistance from foundation-----1.0_ -_.Material _`_ __________________ ? No. of compartm nts-- Size-- r6 4/0------Liquid depthCapacity- o. Disposal Field: Distance from nearest well..eA c, ±----Distance from foundation---- __ -.......Distance to nearest lot line---k [ ;= ------- Number of lines--______./------- -en Length of each line____ ¢ eCN� F g Width of trench Z - Type OT filter`material__1,.-------------Depth of filter material ------------Total length"__. _6 �'„A 4 Seepage Pit: Distance to nearest welt �" `ffi`"=� ` �' �`r ,��—_.____._Distance4from._foundation-"___-n'--?__ __.Distance to nearest lot line..__��.___.__--- Number of pits.__-__!_____________Lining material____- Size:'Diameter._ be th-_ :�_'......... p Z-0----------------------- f Cesspool: Distance from nearest well-------------_..__Distance from foundation:-.._._.______.._._.Lining materia :_,_-- ------------- Size: Diameter ------------- Depth--------------------------------------------------._Liquid Capacity--------- gal I S. Privy: Distance from nearest -------------- well_____________________-_ _____-.___._Distance from nearest building ❑ Distance to nearest lot line. ''--------------- ------ ------------------------ ---------------------- Remodeling and/or repairing (describe):_ g---�-.-,---,•- -e -- --------- 107 - Zk -------- .__------ .-.. ---- •• ---- - -- _ --------• -- -------------1 ------ - ___.______•--------------------- -- ------- ---- ----------------•-------------------•-------•---------------------•--------•--•-------------•---------------------------------^--------------- 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) - - - `--------------------------------------------------------------------------------------------- ---' ----- 9W Contractor) : BY� .` - / . Title ------------• ------•--- -------------- '+,! (Plot plan, showing size of lot, location of system in relation to wells, buiidings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- -- ------------- ------------------------------ ------•-------------------- ------ DATE 7- ----- - REVIEWEDBY------------------------------ ---- ------------------------- - DATE--- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE....... Alterations and/or recommendations:----------------------- � ------------•----------------------•--•---•---- - -- ------- -----------------•----------------------------- ------- �- .— ----- ------- �'' ----------- .........�-- - - --a -------- --- I! ---- 2 ---- ------ 5 FINAL INSPECTION BY:. == -------- ------ ------ ------------- ae---- �� . - -----. o SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street '300 West Oak S+reet 132 Sycamore Street 614 North "C" Street 4 Stockton, California Lodi, California Manteca, California Tracy, California rS-9-2M 145446 ATwaoo 12-54