5640 - Laserfiche WebLink

Home Browse Search

2(fotl L.a l�s� fie. APPLICATION FOR SANITATION PERMIT Permit No. 3P............ (Complete in Duplicate) Date Issued Applica-%n 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_Czl-t& a' // �r Owner's Name ._.._Qi[--�:-- - �--- C,....... '" one----•---•------------_------------ Address --/ � -- Contractor's Name-------`/. /JC -------------------------------------- •• Phone----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ----�_ Number of bedrooms ---/_ Number of baths --- Lot size .©_._ _/.0.0--------------------------------- Water _--___•- ------------------ Water Supply: Public system ❑ Community system _. . ft� 9Private ❑ Depth to Water Table . gt Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ lay, Adobe❑ Hardpan ❑ ,� Previous Application Made: Yes ❑ No New Construction: YesA No ❑ TYPE OF INSTALLATION AND SPECIE CATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) _ -' Septic Tank: Distance from nearest well,51l 10 �'Distan fo foundationf ___/.d_.______.Materjal__ i9 �] No. of compartments_-__ _�__ _._.Size_-3 -r�`--- ..:._Liquid de th___-______ Capacity d Disp sal Field: Distance from nearest well-5-0-Pi-Distance from foundati n-______l1 Distance to nearest, Number of lines___--�• _ _____________ __Length of each Iinet2 n,?- Width of trench-__. Type of filter material--67-1"Iif?., .Depth of filter material-----,/_ _`l!_____._Total length...... ------------------------ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line................. (i ❑ Number of pits._...-.------.--------Lining material-----------------------Size: Diameter_______________________Depth._____---_.______-._____......... �f1 Cesspool: Distance from nearest well-___________ ___Distance from foundation Lining material__-----_-..._-__________----_______-- ❑ Size: Diameter---- •---------------------Depth---- --•------ ----- -------- ---_Liquid Capacity-.......................---gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----------------------------- _. ❑ Distance to nearest lot line ----- --- - ------- -- --- ----------------------- ------------------------------------------------------------ •-- �Iindlo, rep irin (des ribe) ------ ---•- ------- -----•-------------- ----- ••--------•--------• �.7 11 .' h,c c -C---------�--=---- ----- 1 " y',� ' I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. 1k Sined ,_- ------------------------------------------------ By: ______.___ __ _____Owner and/or Contractor BY•------------------------------------------- ----------------�--------------------------------------------------------------...(Title)---------------------------------------------------------------- (Plot plan, showing size of lot, Iota ion of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY-------_---------------------- -- - --- ---- ------------------------------------------- DATE--------------- REVIEWED BY _. _._-____ _ _ . DATE___- _.r r --------------- ---- --------------------------------------- - BUILDINGPERMIT ISSUED................................... `= -------------------------------------•--•• DATE......-------------- Alterations and/or recommendations--------- ----- ---------- ---------- ---------•-•---••-••-••--•-•-•-•-- ....... ------. •-----••. ---••- •----•-- ••----...------_.. FINAL INSPECTION BY------------------- ---------------------------- v Date---------/ __1 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 Revised W-2100