12004 - Laserfiche WebLink

Home Browse Search

/see, � Z- APPLICATION FOR SANITATION PERMIT Permit No. .fd d_ (Complete in Duplicate) Iy 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 WCAJION___IA,1_2__.__.�___ _------------�:--------____________________ Owner's Name ' Phone. ------------- Address----------rL �Z- ----- 1a Contractor's Name------- ------ ----------------------------------------------------------------------------------------------------------------- Phone-----_--------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _- -__ Number of bedrooms ___ __- Number of baths ---I... Lot size ----S.I_'7.9_.___-X-f 0.0___--__--___ Water Supply: Public system E] Community system A( Private E] Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ Noor New Construction: Yes4� . No ❑ FHA/VA: Yes ❑ No,vf 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 found a�n....l_Q---------Mat ial ------ ---------------------.4- _C& .P, No. of compartments Size. g .. q p p y._..�-� --._-- p ----� ------ `' K � . Liquid depth a acct Disposal Field: Distance from nearest well_,s5&_0-_Distance from foundjtion......ko..,pistance to nearest lot line._,._...._ �( Number of lines-------?-- _____ ____________ ength of each line/'�__'-__ S_-..Width of trench____1� __�r__________-_. W J� Type of filter material-__S�)'� th of filter material--------��_-r-"----Total length--------$'10--------------------------- d Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----------------- 0 ❑ Number of pits--.---.---------------Lining material-----------------------Size: Diameter-----------------------Depth----------------.---------------- O O Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-__-___________._______-___________-_. ❑ Size: Diameter------------------------- ------------Depth-----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-----------------------------------------------__Distance from neaest building_____-______________-__________________--- ❑ Distance to nearest lot line - Remodeling and/or repair' (discribe)c----------------- --------- -- --- ------------------------------------ -------------------------------------- a...�..�--. o--,K. -., 1 f ------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County r na ces, State laws, and r es and regul ions of the San Joaquin Local Health District. ordinances, _. ---------------------- ---------------------------------------------------------------- Owner and/or( 9 )� ( / Contractor) � By:------------------------------------------------------------------------------------------------------------------------------------(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------------------------------- ----------------------------------------------------------------- DATE-----4:11 ; --------------------------- REVIEWEDBY---------------------------------------------------------------------- --- --- - DATE----- ------------------------ BUILDING PERMIT ISSUED-------------------------------------- - ------------------------------- DATE----------------. -�` --- -------------------- - ----- - Alterations and/or recommendations:___-__-:_-_ -- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------- ......----------------------------------------------------------------------------------------------------------------------------.----------------------------- --------------------------- ---------------------------------------------------- -------------- ------------------------------------------------------------------------------------------------------------------------------------ FINAL INSPECTION BY----- ----- ----- -----'--- ----- - ------------ Date------------��-_--- 4�9.o---------------------- 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 , Revisecd 1.57 F.P.CO.