3757 - Laserfiche WebLink

Home Browse Search

375" 7 APPLICATION FOR�ANITATII�O�N PERMIT Permit No_ ____________ Complete in Duplicaff] G � F� 3 Date�_sued . 0/ 3 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. JOB ADDRESS AND LOCATION---= Q ' Owner's Name.......C--------e,7,/-''-- •-- ------ ----- - -------•------------------------------------------------------------------------ -- Phone-- Address �. `T+ -- -=---- ----------------------------------------•---------------------------- ------- -, q Q Contractor's Name------✓�-a ✓` - - -- Phone---/_:L__-4�a_ Installation will serve: Residence [Apartment House ❑ Commercial I] Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms .4-_ Number of baths ___/__ Lot size -_-_ 1 44_l x--_14D_ ________________._ Water Supply: ' Public system Community system ❑ Private [-], Depth to Water Table _-yo ft. Character of soil:to a depth of 3-feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑\,� Previous Application Made: Yes ❑ No [ New Construction: Yes ❑ No 9__�Oy� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) t Septic Tank: Distance from nearest well-_- _O-Y�._Distance unf�atian---------__..._.Ma# 'al____C__��_-_________________ ___ ______ { ®� No. of compartments -----------Size_L1 p 3-Liquid depth--_--- ------Capacity_ ��-- -_a ` Dispos Field: Distance from nearest wel ._ .^Distance from foundation_______ _b Distance to nearest lot lin Number of {fines--------------- --- ----Length of each line----------------------- Width of trench----- _ Type or filter material-142--_-.10 of filter material____-__sr_____._Total length___.___.1_ ___________________________ Seepage Pit: Distance to nearest well_____________ ----------------------Distance from foundation--------------------Distance to nearest lot line______________.._ ❑ Number of pits----------------------Lining material----------------------.Size: Diameter-------------.----------Depth_----------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------------------------------- El Sita: Diameter--------------------------------------Depth--------------------..------------------- -----------Liquid Capacity_ _.---=-9als.� Privy: Distance from nearest well------------------------------------------------`Distance from nearest building------------------------------------------ Distance g -____.____-__-._.__________- Distanceto nearest lot line--------------------------------- ----------------------------------------------------------------------------------------------------------- Remodelingand/or repairing (describe):------------------------------------- -----------------------------------------------•-•-----•--•-------------------------------•------------------------ r ------------- --------------------------------------•---------------------------------------------------------------------•-.-•--------------------------------------------------------------------------------- ------- ---------•-------------------------- ---------------------------------------------I------------------------------------------------------------------- --- -- --- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sfa laws,- and rules and regulations of the Sa Joaquin L cal Health District, y (Signed)..------- +t � (Qwwr an Contractor) --------------------------- ------------------ Title (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- r DATE-- - ---------- --------- -------------------------------- REVIEWEDBY--------------------------------- ------------------------------------------- -------_-_------- ------ DATE--- ------------------------------------------------- BUILDINGPERMIT ISSUED-------------- ------------------------------------------------------------------------- DATE------ ---------------------------- - Alterationsand/or recommendafions:.---------------------------------------------------.. ---------------------------------------- ----------------- --------------------- --------•----•--- ------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------- ----------------------- i ------------------------------ -. --------- --- -------------- ------------•-••----------•-----------•-------------- --- ------- ------------------------------------------------ FINAL INSPECTION BY------------------ - --- - ----------------------------- Date---------- --- --- .. k 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 �0-52 Revised W-2100