2671 - Laserfiche WebLink

Home Browse Search

Permit APPLICATION No. _ --?--�__-• APPLICATION FOR SANITATION PERMIT ^ (Complete in Duplicate) Date Issued __-___ _ -_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 ith Count Ordinan e No. 544. JOB ADDRESS LOCATION- ------- --- ----------------- "..� �--- 0 -7.--------------- Owner's Na - ---------------- ---------------------------------------------------- ----- Pho e Address `� - ------ - - -- -- ----- --- -------------------------------------------- ------------- ---------- ----------------j r .. Q fi Contractor's Name---- ----------------- ------------------------------------------- Phone �_-_79. -- -- CN Installation will serve: Resi nce A House ❑ Commercial ❑ Trailer Court ❑ Mot l,�❑ Other ❑ 11 - --f-------------------- c� Number of living units: __�____ umber of bedrooms __I-____ Number of baths -____-__ Lot size _ _____ ___ Water Supply: Public system TCommunity system ElPrivate E] Depth to Water Table -------- ft. t: Sand Gravel Sand Loam Clay Loam ❑ Clay ❑ Adobe �ardpan ❑ Character of soil to a depth of 3-fee ❑ Y Previous Application Made: Yes ❑ No New Construction: Yes No ❑ k TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted i ublic se er is available within 200 feet. Septic ank: Distance from nearest well_ __�ista ce fr fo ation_I f} Mate ill__ _______________________ ___ - -____- {� -- No. of compartments-__--.,-------- ize.....Liquid 4L &7.cci;----Capacity___-• -�_ /---- ---------- ------- -- Dispo I Field: Distance from nearest w II __ __ - Distance from foundation__ f Distance to nearestilt �iy#er�_. ------- y 'Width of trench______ ___- Number of lines------------ --- Length of each line-----____-- -- - it----- r n Type of filter materia __�____`_ epth of filter mate rial________ ---------Total length________ Seepage Pit: Distance to nearest well_____________________Distance from foundation-------- -----. ..___.Distance to nearest lot line________________�\ ❑ Number of pits------------=---------Lining material-----------------------Size: Diameter------------------------Dept h--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-__-_______________--__________------� - ❑ . . __Depth c-- ;- �---�- „ -Liquid Capacity --------------- ---------------------------- Privy: ----- ___________-_Distance from nearest building 1 Privy: Distance from nearest well--------------- -------------- - -----------------•---------- ----------- -------------------------------------------------- Distance to nearest lot line------------------- ------------------ ❑ - Remodeling and/or repairing describe):-------------- I herebSta+ lavisthat and have rulesp nd ared this regulations olf the San Joaquiication and that n Local work Heawill lth D tr c4n accordance with San Joaquin County ordinances, , ---------------------(Owner and/or Contractor) Tale (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 --- ----- --------------- 3 ------------------------------- Alterations and/or recommendations:------------- --- -- ------------------------1___._1------------ -------------------------- -------- ._______________________________ 4 ___________________________________________________ r -------------------------------------------------------->-------------------------- --------------------------------- ---------------------------------- -- -- --------------------------- ---------------- -------------- -----------------------------------------------------I------- v FINAL INSPECTION BY:-------------i?-f?- -----a- ------------------ Date---- ------ ------- - ------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West oak Street 132 Sycamore Street 814 North "C" Street Stockton, California r Lodi, California Manteca, California Tracy, California ES-9-2M 8-51 Revised W-2100