5236 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. . .......-`3___ (Complete in Duplicate) Date Issued 82-.Z- y Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein describ d. This application is made in compliance with County Ordinance No. 549. lA JOB ADDRESS ANDgLOCATION =1- .af2j-� --------- OB ;;v Y ;IG-�------------------------------- - OwnersName---------M-r-5-�-------t�------ �e-�_c��L ------------------- --------------------- --------- Phone Address.....• Q -------�•- r ------- -------- �.� t. _ ---clab f—----------------------------------------------------------- Contractor's Name-------`'� C7-44------•R., � Phone �.�g��. -installation will serve: Residence 9 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -1----- Number of bedrooms �_`------_. Number of baths ._/-___ Lot size __________________________-__________---._.___.______..____ Wafer Supply: Public system ❑ Community system ❑ Private Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ San y Loamid Clay Loam ❑ Clay ❑ Adobe i] Hardpan ❑ Previous Application Made: Yes ❑ No'xNew Construction: Yes X No ❑ TYPE OF INSTALLATION AND SPECT CATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.), i �,,�y Septic Tank: Distance from nearest welI6 0.__�'_Distance from foundation--/ --------___.Material__C_&"._(�_J1 _ , ------------- - No, of compartments- - Liquid depth------- ------_-------Capacity_"�7_ Disposal Field: Distance'I/- from nearest well -�Distance from foundafion_f:A---_.__.._.Distance to nearest lot �i e_ ___ .__--_Length of each line__-----�A.Q_____. Width of trench.--.a_y . El Number of lines--------- ---------------- - 00 Type of filter material__j/&,t�V_ fh of filter material__ _ g.___.____Total length_____ d_______ Seepage Pit: Distance to nearest well----------------------Distance from foundation---.----------------Distance to nearest lot line--_---_._________ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth----------------- ----.-.----____ Cesspool: Distance from nearest well__________._____-Distance from foundation____________________Lining material------------------ __.__.._._____- ❑ Size: Diameter--------------------------------------Depth-------------------------------------------------- Liquid Capacity---------- --------_--_---a,',. . Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ ❑ Distance to nearest lot line--------------------------------------------------------------------------------------------------------------------------------------------- Remodelingand/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 laws, and les and reguullaattion f the San Joaquin Local Health District. (Signed-------------- -----�`---------- - ---------------- ---------------- (Qw`N+�el/or Contractor) By: -- --------- ------------------------------- (Title) (Plot plan, showing size of lot, location of system ' relation to wells, buildings, etc., can be placed on reverse side). DEP RTM ENT USE ONLY p APPLICATION ACCEPTED BY--------- — = DATE REVIEWEDBY-------------------------------------------------------------------------------------------------------- -------------------- DATE--------------------------------------------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------------ - Alterationsand/or recommendations:-------------------------------------------------------------------•---------------------------•--------------------------------------------------------------- ------------------------------------------------------------------------------------- -----------------------------------------....------------------------------------------------------------------------------------ ------- --------------------------------- --------------- •-------------------------------------------------------------------------------------------------------------------------------------------------------------------- -1-----------------------------------------------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