3280 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No_ 1-3___A-f (Complete in Duplicate) Date Issued !'Va 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.' _.WCA JOB ADDRESS AND ' CA' ON_ ---- ---- 10, --------- --- ------ OwnE;r's Name--------- (�- ------------------I ------------------------------------------ Phone------------------------------------ Address---------------------------- Contractor's Name--------------------A OP - ------------------------------------------------------------------------------------------------------- Phone----------------------------------- Installation will serve: Residence [] A arfment House E] Commercial k Trail r E] Motel [-] Other E] Number of living units: -0--- Number of bedrooms __40--- Number of bath r�----A�oSiZee ......1-17.... ----------------- Water Supply: Public system F] Community system E] Private Depth to Water Table ---OR_ ff. Character of soil to a depth of 3 feet: Sand A Gravel E] Sandy Loam El Clay Loam E] Clay E] Adobe E] Hardpan ❑ Previous Application Made: Yes L] No [9, New Construction: Yes JX No ❑ TYPE OF.INSTALLATION AND SPECIFICA IONS:,,, (No septic lank or cesspool permitted if public se%yer is available within 200 feet.) Septic Tank: Distance from nearest well--- Dist nClp f 0 f riclafion---- Mafe No, of compartments____-_--_--- depth-________'r, x ----------size--- Liquid de -------- Capacity--- Disposal Field: Distance from nearest wefi___/ P_Distance from foundation---10----------Distance to nearest lot Number of lines--- ---Length of each line--------*_01 c ------ -------it---Width of trenc Type of flfer material-_ - _-A___may_________ _____Length of filter material-------P?---------Total lengfh__ .� V-oli:&_ Seep6ge Pit: Distance to nearest well-----------------------Distance from foundation--------------------Distance to nearest lot line_______________-- n Number of pits-----------------------Lining material-----------------------Size: Diameter-------------------------Depth------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material_________________--__ Size: Diameter--- ---------------------------Depth----------------------------------------------------Liquid Capacity------ ----- --------gals. rrIVY. Distance from nearest well__ ---7- -- building___-__ . .......... -------------------------- ---------------Distance from nearest ------------------------------- E❑ Distance to nearest lot line-------------------------------------------------------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe):------------------------------------------------------------------------ -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------I---------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------I----------------------------------------------------------------------- I hereby certify hat I hayoe prepared this application and that the work will be done in accordance with San Joaquin Coun ordinancesate la a lel and regulations of the San Joaquin Local Health District. (Signed)---- ---- ----------- -- -- Qt4_-�'---------------------------------------------------------------------(Owner and/or Contractor) ---------- ------- ---------- --- - ------------ --------- -------- ------ _ 4�Tif le)=-----• - -- ------- (PlotIan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). (P FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------------------------ ------ ----------------------------------- DATE REVIEWED BY--_-•------------------------------------------------------- _ - - -_ ----------------------------------- DATE. ------------- BUILDING PERMIT ISSUED--------------------------------------° ---------------------------------------------- DATE- ------------------------ --------------------------------------- Alt lions and/or recommendations: -------- ------ aG ---------------------------- ------ * - 3 -12-- 'r ------------- ------------ 7 --a JiA---4--- X ------------------------------------------------------------------------------------------------- V, --------------------------------------------------------------------------------I------------------------------- ------------------------------------------------------------------------------------------------------------ __:----I------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------I------------------------------------------- ------- ------------------ ------------------------------------------------------------ ------------------------------------------------- FINAL INSPECTION BY:---------------- '14 ---------------------- Date------------------- ----- �3 - -------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wes+ Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California -Tracy, California ES-9-2M 8-51 Revised W-2100