6858 - Laserfiche WebLink

Home Browse Search

[f APPLICATION FOR SANITATION -PERMIT Permit No. .--Ga-_'� (Complete in Duplicate) l/ Date Issued Applica+iom is hereby m "de to the San Joaquin Local Health District for a permit to construct and*ffa• tework'he ein described. T,Iiis application_is main compliance.witli. County Ordinance No. 549. 00, JOB ADDRESS AND LOCA(TI N -------- -- - - ----- ------------ ... Owner's ------------------------- ----------------------- ------------ ----------- -------- Phone------------------------------------ Address-----:f11..7---- lei .�,t• ------------•-----•-•-------•-----------•-------------------------••-•--- Contractor'sName_r ------------------------- -------------------------------------••--------- ------------ Phone ---�._r�__.rl t. Installation will serve: Residence 4_-�4}�eTtment House ❑ Commercial E] Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _"I___ Number of bedrooms _�. Number of baths ._I-_ Lot size ---- �jF` �' Water Supply: Public system ❑ Community system ❑ Private FA__ to Water Table_&, Pft. Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay [] Adober pan ❑ Previous Application Made: Yes ❑ No 9�1�w Construction: Yes ,� A TYPE OF INSTALLATION AND SPECIFICATIONS: ' . ; (No-'septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest we1LS-Q------Distance from foundation----�-�_-!__.Mat�anal---- '-�+��"_-_-___-__- , No. of compartments..._._.:21----------Size_S4 X- --4/-i.....Liquid depth_..----------_.Capacit ---------- D;sposal Field: Distance from nearest wel_J-0.-._-Distance from foundation----40.0"-r_._.Distance to nearest lot line---- --_--___... �- Number of lines-------- ---_._�tLength of each line___"07..,§r' .. r -__-__.._.Width of trench.24-------------------------- _f Type of filter material--- A--- ---------Depth of filter material------ ��.___Total length----- ___-_.___-_ -------------- See age Pit: Distance to nearest well- _��-#_a------Distanc from foundation___A-0..-°-.__..Distance to nearest lot line__-f�-�-_---- Number of pits------I.__.__--_~_Lining material__P�_. ______-Size: Diameter.y?j_'�__.._._.Depth-----.2.0._.________.----____ irlv�a.J ' Cesspool: Distance from nbarest well_________________Distance from foundation_----,--------------Lining material----------.-------_-__.____.-_______ Wv ❑ Size: Diameter------ ----- -------------------------Depth-------------- ---------------`--------------------Liquid Capacity- --------------------------g a I s. , Privy- Distance from nearest well-------------------_-----------------___-----_---Distance from,nearest building_____._______._____---_______._ ._ � + ❑ Distance to nearest lot line- -- ------------------------------------ -------•------------------•----------------------------•----------------------------------- k Remodeling and/or repairing (describe:---------- ------ ------------------------•-••-•----------.....-------.._...---------------------•---•-------•-•--------------•--------- •-------- �_ ------------------------------------------------------------------------------------------------------------------•---------------------------------------------------------------•------------------------ ------------------ c, ------------------------------------------------------------------------------------------•----•--------------------------------- k will be done in accordance with San Joaquin Countyo ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed) Contractor) ' BY= / Title------------------- ---------------------- ------------ fa; 4 (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------------------------- ----- "------- DATE-----".._. " REVIEWED BY - -------------•- -------------------------------------- DATE------- - BUILDING PERMIT ISSUED. ---------------------------------------------------------- DATE .% - Alterations and/or recommendations:---- --------- -- -- - ------------- --------------------------•---------------•----•----------------- --- -------•-•--------------- -------------------------- ------- n ---------•----------------•-------- i FINAL INSPECTION BY..___ .. / -- �---- ---- ----- -------------• Date------`--�-=-------,�-----1��-J----------------------- -------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California 4 Lodi, California Manteca, California Tracy, California ES-V-2M 1454+16 ATWOOO 12.54 _ •� T -