4667 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No.lt4((a-- z... - (Complete in Duplicate) Date Issued -/-_-2 17-IS-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-- --- ---- --- ------- J�� -- ----- .. ... . ....Vr� ................. Owner's Name---. -- -- --- ---- ------------------- ------- - ------------------------ ----------------------- Phone-±0_9' ------ 40 # Address--- -- - ----- ArIlic-A r Contractor's Name-------------------------------------------------------------------------------- ---------------- Phone----------------------------------- k------------------------------------------ Installation will serve: Residence M Apartment House 0 Commercial El Trailer Court E] Motel E] Other E] Number of living units: ----Residence Apartment of bedrooms ---- --- Number of baths I--- Lot size ------- -n---------------- Water Supply: Public system 0 Community system El Private Depth to Water Table J-12 ft. Character of soil to a depth of 3 feet: Sand [-] Gravel [] Sandy Loam 1`7 Clay Loam El Clay El._Adobe[].Hardpan Previous Application Made: Yes D No 4 New Construction: Yes j9 No 0 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public ewer is available within 200 feet Septic Tank: Distance from nearest well-44. _ _ --Distance from found;a:ion_03_19._ ____.____.Material_ -------------- y Capacify__A�.0_17----- x No, of compartments_____.___ _f*L0,_y 7-we , _-Liquid -__..__..Capacity__ .Q-- __-__ Field: Distance from nearest well__�..O-------Distance from fcundafion_,,_$_-_0----- s rance to nearest lot line-.2-0------- Number or lines_______________ Length of each line------ -AW, 1 ____.Width of trench.--- 2 J *-------------------- Type of filter material.- epfh of filter mafer-;aL__, 4� Total length.....zp__4!----------------------- Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------_-_Distance to nearest lot line__.__.__________ ❑ ine----------------- El Number of pits----------------------Lining material-----------------------Size: Diameter-----------.---------- Depth--------------------------- ----- Cesspool, Distance from nearest well-----------------Distance from foundafion--------------------Lining material material- _-__________.____________.___.__Diameter------- -- ---------------- _-De th-----------------------------------------------....Liquid Capacity----------------------------gals. Privy: Distance from nearest well------------------------- ------------------.__ -Distance from nearest-lbuil—di—ng------------- F1Distance to nearest lot line--------------------------------- ------------------------------------------------------------------------------------------------------------ Remodeling and/or repairing (describe):--- -- - ---fit-- --------------------------------------------- ------------------- --- ------- ------------------------ ---------------------------- ---------------------------------------I--------------------- ori p�s- - ---------------------------------------------------- -------------------------------------------------------------I------------------------------- ------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. --- ---- ------- (Signed)--------- ----------- -------------------------------------{Owner and/or Contractor) By: --------------------------------------------------------- -/------------------ --------------(Title)---------------------------------------------------------------- -- -------- (Plot plan, tWowing 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-------e 13 ------------- REVIEWEDBY------------------------------------------------------------ V----------------------------------------------------------- DATE BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------- ----------------- DATE---------------------- -------------------------------------- Alterations and/or recommendations:-------------------------------___------------------------------------------------------------ ---------_------------------ ............. ---------- ---------------------------------------------------------------------------- ---------------------------------- ------ ---------------------------------------------------------------------- ----------I----------------------------------------------------------------------------------------- ------------------------------------------------------------------ -----------------------------•----------------------- --------------------------- ------------------------------ ---------------- ------------------------------------------------- ------------------------------------------------------ - ----- -------------------------- ---------------------------------------------------------------_1--------------------- ------------------ •------ - ------------------------------------------------------------- ----------------------------------- FINAL INSPECTION BY:. Date------------ ---------------------- 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 10-52 Revised W-2100