6229 - Laserfiche WebLink

Home Browse Search

_ e , APPLICATION FOR SANITATION PERMIT Permit (Complete in Duplicate) _ .. Date Issued Applicai-ion is hereby made to the San Joaquin Local Health District for a permit to cons}uct and install wo k herein described. This application is made in campliance,with County Ordinance No. 549. �... �.�—. � .w. . Tri JOB ADDRESS AND LOCATION O -- --------------------------- 4L � A Owner's Name _4-----S------ :! - --- ---------- Address__.. --__----- 1' ' J b S P - hone} r`7t`C�` / Contractor's Name".."-__.__--_-"""U""-_"" � l� � p � s `� � ❑-- p . .. - -- ------ Phone------Installation will serve: Residence A art nt House ❑ Commercial Trailer Court ------------------------ Number of living units: __._.._ ❑ Motel ❑ Other ❑ _ _ 9 �Number of bedrooms` Number of baths __-_�.___ .� Water Su I Publics sfiem T.. {�siz --- ---------------- -- ----- -- b _ - pP Y� �._ Y ❑ "Communit s stem Y Y ❑ Private L� opth to Water Table �-� ft._ Character of soil to a depth of 3 feet: �Sand ❑ Gravel [] Sand Loam Iay-Loam [� Clay Previous Application Made: Yes No s Y ❑' Adobe❑ Hardpan ❑ ❑ []'r New Construction: Yes No 'c I TYPE OF INSTALLATION AND-SPECIFICATIONS: I .. y , *. ! X qi (No septic tank or cesspool permitted if public sewer is available within 240 feet.) Septic Ta Distance from nearest well"" w r Distance .from found tion__ _ _______ Ma#eriaL "k r f' No. of compartments -- :. Size.- - �l . i aqui Capacity.__. Disposal Field; Distance from nearest gll-----i5v Distance from f ndation.,�""�istance to nearest lot line__ t 15 Number of lines.._._.! f " � Length of each line___________ ___Width of trench:_ _ " /i {* Type of filter material F • �) - -------""_ Bepfih offilter material___ " i 1-�.. 1, :- f� Total length ------� t V , 11`Z Seepage Pit: ' Distance to nearest well____.._.._ �"_....Distance from foundation---..---- oundation__ _.___. ""-=.Distance to nearest lot line----------------- I ____.-"____ -- ❑ Number of pits-------r"----- _.--_Lining material-----( ------------Size: Diameter------------- 1-------Dept h.--------------------------- Cesspool: Distance from nearest well.__._______.___ ! Distance from foundation ❑. Size: Diameter _:_- -• ,_.,,...._ ryDe th f - -- Lining material-------------------- --------�.�. sr. h� � . ._� Li uic Ca s�ci q p '----------------- - = gals. Privy: Distance from nearest v�ell�_T"_ I � � r- ---- - ------___...._--_----.-Distance from nearest b0clin ❑ Distance to nearest 4ot'iine..._.- 1-- 9 ' R ------•--------------•------ ------------- Remodeling and/or repairing (describe);;_----_---_----_ ! ---------#-------- ------------------- w ----•----------- ------ ---------------------------------`----------- •---•--------•-------------••---•-------------------------••---•---•-------------•----•---•------•----------------------_i------------------ ----------...__. ' I hereby certify that 1-have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, ate laws, and rules aand,rregulations of the San.Joaquin.Local Health District. J (Signed).-[ ---------------------- B =---------------------(Owner and/or Contractor) -----------------------•--------(Title)----------------------- (Plo+ plan, showing size of lot, location of system in:relation to wells, buildings, etc.,-can be placed on reve----------------------------------------- rse side). 'I FOR DEPARTMENT USE ONLY I APPLICATION=ACGEPTED BY--.."_ . -- -------- REVIEWED -------- -" _. f. REVIEWED BY DATE = "= --- --1 --- ------------------------------------------------ DATE BUILDING PERMIT ISSUED------------- -I ---- -------------------- -------------------- DATE and/or recommendations:.. -_---- --------- ------- 4 - r ---------------------------------------------------------- ------ - ------------ ---------------------- ---•------- a ------------------.- _...._ - ._ - - - ---------- -------------------------- FINAL INSPECTION BY ----- ------------------ ---------------------- w � "_------------------ ..,.�. Date------- ' SAN JOAQUIN LOCAL HE ETH DISTRICT ------------------------ J30 South Amerieen Street 300 Wasf Oak 5freef " -- _ . � " Stockton, California Lodi, California — _814„North- :C'-Street Manteca, California Tracy, California ES--9-2M ; ' Revised W-2100 _.