5009 - Laserfiche WebLink

Home Browse Search

�2 (' APPLICATION FOR SANITATION PERMIT Permit No. .J ..9.4..... (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. JOB ADDRESS AND LOCATION---!1"-- ��*z-' ------ (� %�-'a" -- ------------- - -------------------------------------------------------------------------- ----•------- Owner's Name: g - - Phone o . ----- Address. f l .. ..t---- .Lt d r Contractor's Name--------------- 4..----- .............................................----------•----•---•............--•-- ------•--•-•......•._.. Phone................................... Installation will serve: ResidenceApartmentApartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ...t-___ Number of bedrooms ----!_.Number of baths ____Al Lot size ....X49 0.6_.___-_-__-"_.__--_____ Water Supply: Public system ❑ Community system �( Private ❑ Depth to Water Table e-V_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑' Clay Loam ❑ Clay ' Adobe❑ Hardpan ❑Q Previous Application Made: Yes ❑ No J9, New Construction: YesNo El TYPE OF INSTALLATION AND SPECIFICATIONS: Su (No septic tank or cesspool permitted if public sewer is a ailable within 200 feet.) ` IQ Septic Tank: Distance from nearest well_-4(slpa rc�e from foun_d„ation---I_.r_„__.Mat rial___: No. of compartments. ___________size__'T)1.. x. __--Li uid de th_-__�__.-_:--_____Ca acit � ' p q P� P y---------------------- Disposal Field: Distance from nearest well_4? !V 09§?ance from foundation Distance to nearest lot line_✓�7+... Number of lines-----__.. ->_. --.__LL``Length of each line____7�'Q-f_' _.Width of tren/�h_X_.,,Z.................... Type of filter material__ 1 --- Depth of filter material------ --_--._-Total length.£�__l'}------------------------------ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line................. Q ❑ Number of pits--------------- ------Lining material.----------------------Size: Diameter----•------------------Depth-------------------------........ Cesspool: Distance from nearest well-----------------Distance from foundation-----.--------------Lining material_..------------------------------------ IJ _-______--.-_._____.__.-__- -.-.❑ Size: Diameter------ -------------------Depth----------------------------------------------------Liquid Capacity - als. Privy: Distance from nearest well-__:_____ ____ ___________________________ ___Distance from nearest building---------------------------- ❑ Distance to nearest lot �i�ndd/orrep.ain.ng l.i"n�ei�-1----r-e--d- ---------•----•.-----'-.•w--t---------- --------------------•-------- -••----------------------•--••-•------ ----•---- Remodeli (des 'be): '- !G ----------------------------_---- .............--------------------------------- 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. (Signed)- _Z _12j KAeA_ =_ ” --------------------------------------------------------------(Owner and/or 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 -_ APPLICATION ACCEPTED BY................ ---- - _---- DATE REVIEWED BY--------_---- ��:,��Y f DATE 4 BUILDINGPERMIT ISSUED.............................- -------•-•- .................................. DATE------------------------------------------------------------- Alterationsand/or recommendations------------------------------------------------------------------------------------------------"------------------............................................ -------------------------"""------"----------------------•-"---------------------------------------------------------------------"--"---"---•------------""-"---------..................................................... ----------------------------------------------------------------------------------------------------------- ---------------------•••-"--------------------------------------------------------------------•-----------•--- -----•-•---------------•--•-----------------------•----------- ---------------------------------------------------------------------------------------------- -------------------------------------------------------------- -"""-•-------•-------------------------------- ------ ----- ----------- ----- -------------------------------------------- ----------------------------------------------------- .............. 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, ES-9-2M 10-52 Revised W-2100