8860 - Laserfiche WebLink

Home Browse Search

' {{ APPLICATION FOR SANITATION PERMIT Permit No. 4 (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. l_1 ' r - JOB ADDRESS A LOCATION.-` -- -- �.__.. .- ------..• -------=- --------- --------- --------- -- :.................... .. Owner's Name...: Phone --•--------------- ------- ,r.. -•-- - --- Address-- ----•• )•_.. t_ .. • ........ 1' I +? Contractor's Name.-- •---•• ------ ................................. .................... ................................................ Phone ......:..... .... ......... Installation will serve: Residence ( par#ment House 171Co mercial ❑ Trailer Court ❑ Motel (�; Othar Q` h' Number of living units: _A___ Number of bedrooms _Y Number of baths I... Lot size ...•..V_r.x..i.` ............... Water Supply: Public system ❑ Community system LK Private❑ Depth to Water Table j, ft Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑` ClaAdobe❑ Hardpan❑ Previous Application Made: Yes No ❑ New Construction: Yes Y No ❑ PHA/VA: Yes ❑ No IV 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 fro foundation----- !_G1 ---:.M 14-40.-0.116.. tet- No. of compartments... _."Y�~ Size__, ' T _ ,Y._Liquid depth- _ Capacity !d*--v_. Disp al Field: Distance from nearest well 3-40�.Distan�ce'from found ion Distance to nearest lot lore '? Number of lines_ '_ Length' of each line_. t _ idth`of trench " 'r ,,_ _.__._-, �. / \ Type of filter materia Yi'�!F ._,Depth of- filter material:�_ ____________Total .length,._._l .. YP •... ~ Seepage Pit: Distance to nearest well ----------•-------Distance from foundation................ ..D.istance to nearest lot line_. .,., ❑ Number of pits.,,,---.*. -----------Lining material:_._ ...= f_--Size: Diameter._..._ .__.____. ..._ Depth--------------------------------- Cesspool: __----- - ._---.-- ------Cesspool: Distance from nearestwell........I .....Distance from foundation .:....... ......:.Lining material.................. .....:........... r_1 Size: Diameter._._ g :Liquid Capac --- -- .....•_ --•- ity............................... gals. Privy: Distance from nearest well_______ ______ Distance from nearest building_.-_- ..._-_- ❑ Distance to nearest lot;line----------------------------------------------- ----- -- ------ -•------ --- •--- ---.. :--- Remodeling and/or repairing (describe):---- -------- -- ------ ------- ----: ------------- •••-••---• ••... •....;--- •-•- . ....................................................................................................------•-• •--•- ----.,.. ••••--_.. .._••... ........................_................... ----------------------------•----------------••-•--• ........ ••.....• _-•-••-•---- . --- ---...---•- --•--• •-•------- --- - I hereby certify that I have prepared this application-an&that the work will be done in accordance with San Joaquin eou}nty ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Si ned =9 )----- - =---- • - - ---- -------11------ ----- ----------------------------------------------------------------- , Cohdractorj B ................ ...... --••--• = --------------.................... ............ - ----------- - -- -- (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 s -,�(�/" ___.. __- DATE REVIEWEDBY--------------------------------------- " f;,=Q, ................. DATE. .. .......... BUILDING PERMIT ISSUED - - DATE ' Alterations and/or recommendations -.. • 77--•---Z ------ --•- --7 ---------------------------------------------- •---__l........................................ .---•- ---------------- - ---- -- --------- --------• _----------------- -. 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 d ES-9-2M , Revised 1.57 F.P,CO.