6026 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PIERMIT Permit No. __---------------.._ yAppli C Com lete in Duplicate) y/ { PDate Issuedca+ion is hereby made to the San Joaquin Local Health District for a permit to onstruct and install the work herein described. This application is made in compliance with County Ordinance o. 549. 1 JOB ADDRESS AND ATION_______ , - -- ----- � --------------------- - ~-�/ .s� Owners Nam °,,. ?"= -Q a'�.'4^ � F ne -------------•---••-•--•--•-- Address ''• -------------------------------------------------------------------- Contractor's Name —� = ------------------------------- -------------- Phone-,�--- 4'"e " Installation will serve: Residence�� AprTrdr me House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ JJ___ Number of bedrooms �_ ,Number of living units: _ ,,,�__ Number �f baths __�__,_ Lot size ___ �.:_.,�.��______________________ Water,'Supply: Public system Community system ❑ Private ❑ Depth to Water Table„ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ s Previous Application Made: Yes ❑ N0 New Construction: Ye No E]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�. *°-__Distance from founda tion___-_____------Material-- ___ --_________- No. of com artment�_________________Size , -1 Li uid de th.._ __!_ Ca acit Z�- • P fes`--/;--,�------:�------ q P. �-� - P y--•---�-------- Disposal f=ield: Distance from nearest weft '-Distance from foundatio __n__ ----------- Distance to nearest lot line___ Y Number of lines________________________ ___Length of each line_______ ._ _ Width of french------,---: ... ' Type or filter material. __.Depth of filter material_____ ____,__.Total length___:-_-___�+ __________________ Segpa e Pit: Distance to nearest well��"'-___ __Distance fr-___ _ �ou�Fra�#ation__ _�._=____.Distance to nearest lot li _ 0 Number of pits---- Lining materia r g-__Size: iameter__._�.(-----------Depth------- � "' Cesspool: Distance from nearest welL________________Distance from foundation--------------------Lining material--------..___._____.________________. ❑: Size: Diameter-------------------------------'-----Depth-------------------;,------ ---------------------Liquid Capacity--------- -- ---------gals. t 4- '` `r'`17istaric� Privy: Distance from nearest yell-----------=-------------------- from nearest buildin------------- 9------------------ ---------------------- i - Ell" "T�- 'Distance to nearest lot line----------------------- -- c Remodeling and/or repairing (describe):- --------- { S ____________________________________________________________________________________________________________________________________________________________________________________,,.____...._____._-________________________ ______________________________________________________________________________________________________________________________.__________-___-.__--___---_-_----_--____________________--______.___.___---___.--_--_._--_--_._ I hereby certify that l have prepared this application and that the work will be done in accordance with San Joaquin County V` ordinances, Sit a laws, and rues and rVulati ns of the San Joaquin Local Health District. (Signed)----- - ' —' Owner and/or Contractor) `.. ---- -01 (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be plac6on reverse side} FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_ DATE_ REVIEWED BY--------------------------- .._.. DATE--- � BUILDING PERMIT ISSUED----------- ---------------------------------------------------------- ----------------------- DATE------- : �'\-------------- ---------------------•---- Alterations and/or recommendations:------ --------- ---------------------------- -------------- ----------------------------------------------------------- -------- ----�-3 ' mss` -- - -------------------------------------------- -------•--------- ------------------------------- ---------------------------------------------------------------------------------- -------------------------------------------------------------------------- --------------------- - FINAL-INSPECTION BY:- Date-- -_ �J• �----� 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 { E5-9-2M Revised W-2100