7375 - Laserfiche WebLink

Home Browse Search

aF R APR'HCAn-ON FOR SANITATION PERMIT Permit No. mow.. ,.;�,_-, (Complete in Duplicate] Date Issued _.16A.-... Applic&ion is hereby made to the San Joaquin LI 'local Health District for a permit to construct and install the work herein described. This application is made in compliance with Count Ordinance No. 549. JOB ADDRESS AND LOCATION-- _ -- ----- --•----•------------- --- '� ,�r� r y'-'------------------------- Owner's Name--.----- ; - ------•------ t} Phone Address------- - - --� - - --------- ---�-�------------------------------------- - -•- Contractor's Name------------ ." ------ -----------------------------------------•-------------------------•------ Phone--------_---------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms .../--- Number of baths --1---- .Lot size -------5--a-Y, +' Water Supply: Public system ❑ Community system ❑ Private K Depth to Wafer Table C4V ft., Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑F Previous Application Made: Yes ❑ No k New Construction: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 fee/t.) Septi Tank: Distance from nearest well-.., 0_-_Distant' from foundat�i ,_./_d---.---.Mat No, of compartments...--_- -Z -------Size--- -. -._Liquid depth.-.--- Capacity_:--_ Q _ Disposal Field: Distance from nearest well--- ".-Distance from foundati n------,C._.Q-....Distance to nearest lot line- Number of lines--------- _--___-.-- Length of each line__- __a---_ -,2.-U.Width of french.-..-- ------------------ Type of filter material___- X [Depth of filter material--..-- $-------Total length-__---. . -___________•,_•-- Seepage Pit: Distance to nearest well----------------------Distance from foundation--- -------------Distance to nearest lot line-_-----__-.- ❑ Number of pits----------------------Lining material---------------------- Size: Diameter----1-----------------Depth-------------------------------- cesspool: Distance from nearest well-----------------Distance from foundation.__---------.--Lining material--------------------_-----.--_------ ❑ Size: Diameter--------------------- ----------------Depth---------- ----------- •------------------------Liquid Capacity----------------------------gals, Privy: Distance from nearest well --._.+-----------------------------------------Distance from nearesf building--------- ---------------------.--------- --__❑El Distance to nearest lot line---------- ------ ------------ Remodelingand/or repairing (describe)-------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------- ..-----------------------------------•----------------------------------==---------------•---------------•------•------------------------...---------------:-------------------•--.-. ---------------------••-------------------•---•-----• -------------------------------------------- ----•---------------•----------------•----•--••-•--•-------•-------- --•-•--•-------------•------------------••----------- -------------------------------- ----------------------------------------------------------------------------••-•---------------••---------------•-•----------------------------•--------------------------------------------- I hereby certify tha+ 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. ic- i (Signed)/-9----- r ---- .-- ------------------- - ------- ------------------- ------- ------ -----(Owner and/or Contractor) l�M�s�_> By------------ ----• --------------------------------------- •---------------------------(Title)------------------------ (Plot plan, showing size of lot, location of system in relation to wells, buildings, eft., can be placed on reverse side). FOR DEPARTMENT USE ONLY �- - -I APPLICATION ACCEPTED BY------------- -------- --------_--- ----- -------------_--------------••------------ DATE- _ - - - REVIEWED BY---- bATE-- 8UlLDING PERMIT ISSUED ------------------------ ;. DATE ------!ll--------------------- ------------------ Alferafi ns and or recommendations:. -;L 4 - .r�.lr9f :c a - -.- _ 41; te14 -� ------------ -------------- ---------------------------------------------------------------------------------------------- --------------------- ----------------------- ------------------------------- ------------- -------- -------------------------------------------------------- FINAL INSPECTION BY: --------- ---....... ---- Date_---fr --~---5-1---------- ------------ 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 [45446 ATWOOO 12-54 i{ , A t