5538 - Laserfiche WebLink

Home Browse Search

� APPLICATION FOR SANITATION PERMIT Permit No. _".....--"----..---",... + ' (Complete in Duplicate) q - Date Issued __--� .____ A lira{ion is hereby q I�7- 0 Y`0--aS pP y made to the San'Joaquin uin 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. :fir 12 p JOB ADDRESS AND LO '. Fl`1��1 _s��2a°- Q -11P Owner's Name = =--=----------------- e �`• G° ' Phone f--- �r�6f ----------- -----•-- -------------------------------- � � �� a• r .... Address :. ------.... / �----------------------------------------------------Contractor's Name---- � = . t-7- ------- �-7 p ------------- -----------------------------------------•--- Phone-- I Installation will serve- Residence 9l' Apartment House❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number ofdiving units:•__"Y Number of bedrooms -6--- Number of baths ._. Lot size ------_ _ _�_aC / Water Supply: Public system 9- Community system ❑ :`Private E] Depth to Water Table,;57�?ft. - Character of soil to a depth of 3 feet: Sand ❑ Gravel Sand Loam Clay Loam Cla ❑ Y ❑ y ❑ y ❑ Ado6eld Hardpan ❑ Previous Application Made: Yes F]1. No No �ew Construction: Yes ❑ No i .�- ,�-C TYPE OF INSTALLATION AND SPECIFICATIONS: .(No,septic tank or cesspool permitted if public sewer is available within 200 feet.) — wo r Septic Tank: Distance from nearest w I1_AVDistance from foundation-_�0 --.____.Material----No. of compartments__ �----- - U_ " Ligwd depth Clr-t .".--_-_C__ a actSize "---- - - Dispasaf Field: Distance from nearest well_-1 01LO-Dista ce from.foundation--- ----------Distance to nearest lot line--- Number of lines----------�_.._�__�r_- ------ of each line"��-Q:f-��____-Width of trench__` __5 ,r +Type or fitter material"--�."_]r--" ._-k Depth of filter material---_�-- --____-_"Total length--j-0---------------------__ Seepage Pit "` j _ Dis#ante to nearest well�_�YI.Q�______Distance f{�om foundation_"...��.�__.Distance #o nearest lot Number of pits.tI---------------Linin materials UW1L51__.Size: Diameter---..3.3Depth Cesspool• Distance from nearest well-----------------Distance from foundation._, ---------b-----Lining material---------------- _---" Ill` ❑ Size: Diameter- --- Depth --- -----------------------------Liquid Capacity--------•-------------------gals. Privy:, Distance from nearest well------- -------------------------------------------Distance from nearest building---- i ---------------------•-- ----------- ❑ Distance to nearest lot line-- ----------------------------------------------•---------- 1 l Remodeling and/or repairing (descriL�e): ---"--------------••---------•---------------------------------I-I---------------- r 1 -----------------------------=--•---------------.-`--•-------•---=-----,-- --------'--------------------------•----------"---------------- ------------ -'' `:..� ! hereb tify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, tate aws, an rule d'regulations the San Joa uin Local Health District. (Signed)------- --!!1�!l�'.. . ------ - �✓-------------- ------ -- -------- --- Contractors - - - Title c { 5 } Q11 (Plot plan, showing sire of lot, location of system i relation to wellst dmgs, etc., can be placed on reverse side). OR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------- --- -- - DATE.-------- REVIEWED BY - ------- DATE-------- "`` ------------------- ----------------------------------------------- BUILDING PERMIT ,ISSUED DATE Alterations and/or recommendations:'_:___"_-----. -•-- --------------------------------------------- f------------- ------------------------------•------------------------------------:-----•------•---------- - � - - . -------------- ------------------- -------------------------- t' _1_1r------ -=------- •-�''� --------��1� �-fi-z-_� " FINAL INSPECTION BY---------- -- ----- ----------- - ---------- -------------------- -�.. •Date--------��•" SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street —132 Sycamore Sfreef i� 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E5-9-2M ; Revised W-2140