SR0082950 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. ______________ (Complete in Duplicate) `� r Date Issued Application is 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 ounty Ordinance No 649. 1'45z6 ^U� N. ROLL-Nf 4- .,f�a P�I.D '11-r7Cl�XX�= 41-4.4..-..--.-_---------•-- JOB ADDRESS A L CAT ON-5.......... ..... �.Q-!--- ----------------•-•.- ,��,,//�� } Phone.................•....- = Owner's Name........_!,ll,l. ,.� .1-.: r.:• -- Address----------•----3 ..1...._'ffi+x.- ---•------ ...-.....................................-.....................------------...-- - .... Contractor's Name------------- --•--•-----•-••-•----- ....................................._...................................------ Phone-_.!.......a--- ........ Installation will serve: Residence ` Apartment House [] Commercial [-] Trailer Court [_-] Motel ❑ Other (Ii t0.- - -Number of living units: _.�..:: Number of�bedrooms�:� _s umber•of baths ._.._... Lot size __ -�-; - Water Supply: Public system ❑ Community system ❑ Private N1A Depth to Water Table /-,Jeff. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam❑ Clay Loam ❑ Clay❑ Adobep' Hardpan ❑ Previous Application Made: Yes ❑ No New Construction- Yes Ok No.[-] TYPE OF INSTALLATION AND.SPECIF(CATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well.... Distance from foundation. tertal _ Ca acit Y .-- - V1' Liquid depth..._....Ho. of compartments..... ....... . ... _.._._ Disposal Field: Distance•from nearest well----4... ..Distance from foundation............Distance to nearest lot 5ne.,;,�______._- Number of lines---------�} ... . length of each line./.l�Qi.`1F_�_ e._.Width of trench__�- j ! `+.................... Type of filter ntaterial._:S .t'Iepth of filter material...,�:�#.............Total length._.....f-�+�___...._._.,__.__.___ .,Seepage Pit: Distance to nearest well......................Distance from foundation....................Distance to nearest lot line----------------- + ElNumber of pits......................Lining material....--___--_-__.-----Size: Diameter......................,-Depth----------_�__.._......._:__;__ Cesspool: Distance from nearest well................Distance from foundation............_......Lining material_-...... ........-.__._.____.... ❑ Size: Diameter--- Capacity......•----.....---•--•-- g4, istance romn`earesf'6ilclin j Privy: Distance from nee rest well ......................•-.....: --- 1 �..._.._...�..... - ❑ .,, Distance to nearest lot lin ...,. .......... • j� 1.x.....1 ' --------------------- 40" -._.-...... 40 AAA. Remodeling and/or re iring (describe); ........................-• - 1- .....--- � � - ..........-......-...............--•-•---•---•-----. .....__ � - ._ .._L .-., 3.__ s. .......................-........................-- ••--- -- - -..........................................:.-.............................-_................................................. I hereby certify that I have prepared this application and that the work will be done in accordance with Sen Joaquin County , ordinances, State laws, and Z-0 d regulations of the San Joaquin Local Health,District. >� ..- _. _ ......------...........................................(Owner and/or Contractor) i (Signed)---•-•--•• s-:r:c „ _+ ,.� eo��---•--..-. BY: - -- J...•---.._...................................................-------------(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 APPLICATIONACCEPTED BY............................ -•.............-.......:..•-•--••-----..._...----..........._... ..........-•------------------------------------------------ REVI,EVYED BY................ .. _ _ :- �,/�� DATE. : -• BUILDING PERMIT ISSUED--•--- _..:. ..�.., - = DA`fE..._... c':` ... ..._.... .� Alterations and/or recommendations:_------•----•-------•--......................... ...........................................-..---------------------•----....._.....---•-•-•-•--------•-- .................._.------.........-----•--------------.......--•--......------.............---•----------•------------------••-•----------•.............:_...................................................... ----------•-•-••••-•................... _ ..................................... . . - ... ............_. .............._......_.---•--•-•--....1- •._.... ........---...... ------------•-- - - ................. - ------ -------------•--------.----•---------------_-_---.--.-.......--•---••-•--••------------------- i /.....-....r� ::... . --••--•-•-- Date .._... 1. FINAL INSPECTION BY:...... ..... _-- -- 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 8.51 Revised W-2100 /