3359 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. �---------_---- (Complete in Duplicate) Date Issued 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-------. ( _ ..- f=�- - -- --� - Owner's Name-------------------------------•----•--- Phone = l Address ----•S---�`-"-----—'---- Contractor's Name---- -------------•---....-----------•- -------------�...-,r.,----------------------------------•---.....-------------•--------------•------------------•---- = - -------------------------------------- Phone------!••-- '- A-7 - F Installation will serve: Residence gr_ Apartment House ❑ Commercial E] Trailer Court E] Motel ❑ Other ❑ Number of living units: j____ Number of bedrooms-,?-- Number of baths/----- Lot size ---�.qr_A__Y--I----T-4----------------------- Water - ______________Water Supply: Public system ❑ Community system ❑ Private 9,Depfh to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 2q Hardpan ❑ Previous Application Made: Yes ❑ No j"ti New Construction: Yes RT No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) . f Septic Tank: Distance from nearest well---- Q-----Distance from foundation-- Material - C� No, of from foundation---3" _______Liquid depth___._ _�"�� `__--_-Capacity---r -.---- Disposal Field: Disfance from nearest well-70 from foundation./-_fir---------Distance to nearest lot line----447 Number 0.1 lines-------/-.-_. Length of each line-- *-_"'___.__-_-.Width of trench.ca�__4!'�_________________ r A,- Type or filter material___._ ---- ___Depth of filter materia ___ ---_ ------"-.-____Total length___-+ - -'_--.__-_____-._- -� R Seepage Pit: Distance to nearest well-10-0 epp f,,��r,o��m foun tion____ __________Distance to nearest lot line_____________ Number of pits_.._________________Lining ma eriaL-✓4rf _..S ze: Di 4 eter------- `�_ Depth_-_ t ---__--___----------�� Cesspool: Distance from nearest well-----------------D nce from founfdat' ----------------..Lining material----.-__----_--------___._____.______ ❑ Size: Diameter-------------------------- ---- ------Depth--------------------•--------------- --------------Liquid Capacity-----------•---------------gals." Privy: Distance from nearest well_______________________________________I--------Distance from nearest building------..___------______.__.___.__________ ❑ Distance to nearest lot lire--------------------------------------- -- -. Remodeling and/or repairing (describe):------------------------------------------------ --------------------------------------------- ----•----------•-------------------------------•-- •. ---------------------•----•-------------------•-----•---------------------------•-------- .v f -------••---•------------------------------------ --------- have prepared this -- lication----------------------------------------------k ------------------------------•------------------------------------------ ordinances, y certify ate €awe, a d rules and regulations li the, S and that +he work will be done in accordance with San Joaquin County I hereby certify that I ha. p p pp San Joaquin Local Health District. (Signed)----------------•----------- -•----1 --------- 4- r J -----•--------- ----- - ---------------------------------( aet an -Contractor) By:---------------- _ �1+__GAJ Plot plan, showing size of lot, location of system in relation +oma ells, build , eFc,an(bele}lac on neve e � ( p g Y 9 p ) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- --- ! ---------------------------------------------------------- DATE REVIEWEDBY------------------------------------- ------- ---------------- ------------------------------------------------------------ •- DATE------ '-- -'_70_-5 BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE-------- ; Alterations and/or recommendations------------------------------------------------------------------------------------------------------------------- •--------_----•---- --------------------------•---•---------------------- -------- ----------- ---------------------------------------------• -------------------------•------•---------------------------------------- r -------- ------ ------ Date--FINAL INSPECTION BY:. �4u4A 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