6424 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No- lo_ Z--------- (Complete in Duplicate) / . .._.... � Date Issued ��Applica4-ion 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 NP. S49. JOB ADDRESS AND LOCATION__:____- _ a C - - Owner's Name--_--6 4__ _b/-------------- -- Phone -�-- / -- --lP` G_9 Address Q -••--- ------ Contractor's Name-------- ----- ------4�_Ik------- r----- -- -•----------•--------------------------------------------- Phone---/V, _7 l Installation will serve: Residence ] Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ I Number of livingunits: __ Number of bedrooms _ .f__ .,�___ Number of baths Lot size _____62____x_____��D Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table -�a___ ft, Characterof soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe M Hardpan )] Previous Application Made: Yes ❑ No W New Construction: Yes ❑ No &XI TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) , ' .......... t Septic Tank: Distance from nearest well__/1/t'71,L _Distance from foundation._.-/o------•---.Material_.___-_ C�__8. ._ - No. of compartments _________________Size____-_-. p --✓�cX6_Liquid depth_----�0_�_.._-----.-Capacity---- '- ..------------ Disposal Field: Distance from nearest well_________________Distance from foundation--------------------Distance to nearest lot line__________-_____ ❑ Number of lines}-------------_------_----------Length of each line------------.__---------------Width of trench._----------------------------_---- Type of filter material----,__-----------------Depth of filter material----------------------- length------,_--________-.__________.__________ Seepage Pit: Distance to nearest wel€__/--(t!e ---Distance from foundation---/_a----------Distance to nearest lot line--__;j__-___ { ®, Number of pits_______ -----------Lining maternal__C'4_ - .Size: Diameter._. __-...___ p ! Cess ool: Distance from nearest weld--------_________Distance from foundation---_----------------Lining material...____---.--..___________._____-___ p --- - - -- -- --------Liquid Capacity gals. ❑ Size: DiamefeC� ___T--------- ---------De th---------- Privy: Distance from nearest well--_-..______-_._ .__________._._.__.___-----Distance from nearest building------------------------------------------ d ❑ Distance to nearest lot line------ ----------------------- ---- -I---------------- ------------------------------------------------------------------------ ------------ Remodeling and/or repairing (describe):---------.____:___ I �. ----------------------------------------------•--------- ----- ---------------------------------------------..._ I _____---------------------------------------------------------_----------_--------------------------_------------__________________________________________________________________________________________________,..__.---__ f hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Counsy-�- ordinances, Sta a S. and rules and regulations of the San Joaquin Local Health District. (Signed)----- ------------------------------------------------------------------ ------------(Owner and/or Contractorl , 1 By: ----------------------------------------------(Title)------- -t------------ -- - - --------------- (Piot 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------------ 6 - Alterations and/or recommendations------ ----------- �_------------- -----------•------------------------- --- ----- ---- 1� E ---------- --------------------•----------------•----•--- ----------------- ------------ ------ -------------•----- --------------------- -• FINAL' INSPECTION BY:.-- ------------- ------------ Date----- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street l 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES--7-2M 145446 ATWOOO 12-54