4101 - Laserfiche WebLink

Home Browse Search

APPLICAT ON FOR SANITATION PERMIT Permit No. _.._._.._l�.f.... (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 San Joaquin River Club„ just east of the Farm House ------------------------------------------------------------------- ---------------------•--------------------------------------------------------- --- H . Owner's Name........................................ e--p-..-_T�3Sk1n ------------------------------------------ Phone------------------------------------ Address.............................................. . PAP'-- 0• Box No, 100, Holt -----------------------------•---------------------------------------------------- RRISH IN C --------------- Phone.?"96o7.... Contractor's Name-------------------------------- ---------------------------------------------------- Installation will serve: Residence [4 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ 1 l ---- Lot size _.._� ______________________________________________ Water Supply: Public system ❑ Community system& Private ❑ Depth to Water Table ........ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ] Hardpan E] Previous Application Made: Yes ❑ No$] New Construction: YesU No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 2001 at CC Brick Septic Tank: Distance from nearest wef)_________________Dist�,rwj f g,,foundation__-_-_-______-___-_.Mt lal_____-_.__-._.-._-._-_-----___--.....____..__... No. of compartments. G Size�vq Liquid depth. 2 Capacity900 CT`3---'8 , 2�0 t 63deep 101 t � �. Disposal Field- Distance from nearest wellA ________________Distance from foundati99n__ Distance to nearest to line_. ___.___..__. Number or lines_____________ Length of each line-----�? _� _ Width of trent L v: Type of filter mate24 rial_____ ________ _____Depth of filter material----___----------------Total length....------____-________-___----_-_--__.--_A Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line-----..----_._--- V ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth--------------------------------- 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--------------------------------- ------------- ---------•---•-•-----•- -------------------------•------------- - -----------------------_ Remodeling and/or repairing (describe)----------------------------------------------------------------------------•-----•----------------------•----------•-----------------------------------. -------------------------•---------------------•----------------------------------------------•--------------------------------------------------------------------------------------------•-------•-----------------•-----•- --------------------------•-----------------------------------------------•----•----------------------------------------------------------------------------•---------------••-----------------•-----•------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State I s, and rules and regulations of the S n Joaquin Local Health District. • PL;<RRISH (Signed)•---- _--i-aL. (t � � Contractor) Title Estimator (Plot plan, o e of lot, location of system Filatio) to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- ------------ ---- - -- -------------------------------------------=----------- DATE-- REVIEWEDBY --- ------------------------------------------------------ DATE...�c,/.- --S.S BUILDING PERMIT ISSUED.............. - -----------------------------------•---------------------...-------------- DATE-------------------------------------------- --------------- Alterations and/or recommendations:............................................................................................................................................................... ................................................I---------------------------------------------------------.......................................... -----------............................................................. ------------------------------------------------------------------------------------------------- ------------------------------.......................................................... ---------------------•--•- ------------------------------------ ------------------------------------------------------------------------------------------ -------------------------------------------------------------------------------------------- -----------------------------------• ---------------- --- -- ----------- 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