7528 - Laserfiche WebLink

Home Browse Search

y A 1" I V I APPLICATION FOR SANITATION PERMIT Permit No. .. (Complete in Duplicate) Date Issued _ISf_51!`-Sf- # - j Applica{ion is hereby made to the San Joaquin Local Health District for a permit to construct and install+he work herein described. This application is made in compliance with County Ordinance No. 549. _ n JOB ADDRESS AND LOCATION----------31 Q--5---------/J `4�"�' ----------------------------------------------------- Owner's Name '' ------------ --------- --------------•------------------------ ----- ------------------------, -------- Phone----•----•-•------------------------ Address -7-6 �-�- ------------------------------------ Contractor's Name------- - •- ---------------------------- Phone/-//0 (.0_. Installation will serve: ,Residence M,- partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: /---_- Number of bedrooms __'Number of baths ._r-_-- Lot size --------=�/- =____ 4 --- _________________ Water Supply: Public system ❑, 'Community system ❑ Private ❑--Depth to Water Table _ Q ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe QHardpan ❑ Previous Application Made: Yes 0 No M, New Construction: Yes K No ❑ 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 foundation-------------------Material_-:---_-----____-__---.-_--__---,-_-----_-.---. ❑ of compartments--------------------------Size--------------------------------Liquid depth--------------------------Capacity----------------------- Disposal Field: , Distance from nearest well-.___._....___--Distance from foundation--___..............Distance to nearest lot line----------------- Elbar of lines --------__----=------------------Length 'of.each line------------------------------Width of trench----------------------------------- of filter material.........................Depth of filter material------------- --------Total length------------------------------------------ TTP page Pit: Distance to nearar est well... =_Distance from foundation----e"A_ __.Distance to nearest lot line__ ee� Number of pits.__J---------------Lining matersaL________-_ 3*e: Diameter_43'..7-------------Deptn__,-?�___ _________.-_- Cesspool: Distance from nearest wefl-------------_---Distance from foundation Lining material--------.--------------- _-------_ ❑ Size: Diameter--------:--------------- -----.Depth-------------------------------- -------------------Liquid Capacity. --------------------------gals. Privy: Distance from nearest well-------......:_?-----------.---------------------Distance from nearest building----------------------------------- Distance to nearest lot line----------------- -"'^___-. Remodeling and/or repairing (describe):---------------------------------------------------------------------------------------------------------------------------- ----------------------. � ----------- ----•-•------------------••------•-'-----------.---------•---•----------=-=-------------------------------------------•--------••--------------------------•--------------------------------------- ------------------------------------------------•----------...--------------- -•--------------------------------------------------------------------- t I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Staten s, and rules and regulations of the San Joaquin Local Health District. (Signed)--- ` ? --:----�A -------- --------------------------------------------------------------- -----((Owner and/or Contractor) By:. fZf. tea.`. (Title) f'" (Plot pian, s owing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side]. i FOR DEPARTMENT USE ONLY I APPLICATION ACCEPTED BY - ----------------------------------------------------- DATE---------�--------------------- ----- --------------- REVIEWEDBY---------------------------------------------------- --------------------•-------------------------- --------- DATE------------------- > BUILDING PERMIT ISSUED-------------- ---------------- --- ---- --------------------- ------------------ ------------- DATE----------------- ` Alterations and/or recommendations:------------------------- --------------------- �--- J - --- - -•-•----------------------•----•---- •------- _ -•-- -- - ----- -------------- ------------------...•-------------------------------------------- ----------- •-- -------------------------------- -- -------------------------- FINAL INSPECTION BY----------------------------- ----=---------------------- Date------------------------------------ ------�--------... I i SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 614 North *c, Street Stockton, California Lodi, California Manteca, California Tracy, California ES 9-zm 145996 ATWUUD 12.54 f