7400 - Laserfiche WebLink

Home Browse Search

*Vlp� APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) , 3 Date Issued --- �Iq_5�.. Applica4-ion 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. /�J JOB ADDRESS AND LO ATION /_ -U- ---- --------- - --------------- Phone--_---------------------------- Owner's Name-------- ,.; _. Address—------------- tC�1 . ---------------a-------- - ------------------ . -------------------------------------•----'--- ---------o----------------- Contractor's Name-- ------it(•-- ------------------------------------ ---- Phone A_7 Installation will serve: Residence [` (Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: y2__ Number of bedrooms __. Number of baths ___'__—Lot size --_----�� 7�-----J� -----.------- Water Supply: Public lsystern�ommunity system [I Private 1_] Depth to Water Table..�r___^ft.� _'" Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ .Clay Loam ❑ Clay ❑ Adobe12kHardpan ❑ i Previous Application Made: Yes ❑ No 51--- New Construction: Yes Pg.—No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: i (No septic tank r cesspool permitted if public sewer is available within 200 feet.) i Septic Tank: 'ti ' Mance frominearest well_________________Distance from foundation---------------------Material------------------------------------------------ . ❑ compartments- ------------------ Size ---------------Liquid depth=-------------------------Capacity------- ----=---------- �. Disposal Fie d: e from nearest well-----------------Distance from foundation------------________Distance to nearest lot line,--.------------- ❑ lines----------------------- --_.,,-:_Length of each line------------------------------Width of french----------------------------------- ` Type filter material-----------------.---___'Depth:of filter material-------_--------------Total length----------------.---•---------------___--- Seepage Pit: Distance to nearest wellDistance from foundation....-4_B_--------Distancejo nearest lot line_____ __0___ Number of pits-------f__ -------Lining materiaL_e-4?-Ag�w E�- Diameter-------9_3.......Depth-------dc�______�_----------------- 3 Cesspool: Distance from nearest well __I------------Distance from foundation--------------------Lining material--.------------------------___._____- ❑ Size: Diameter---------------------•-------- -Depth---------------------------------------------------Liquid Capacity----------------------------gals. L_ i Privy:€ Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ ❑ Distance to riearest:lot line----------------- - -- ------- - .--------------------------------------- ----------------------- k Remodelingand/or repairing (describe):----------------------------------------------------------------------------------------------- ----•-----------`---------------------•----------------- # ---------------------------------------------- -------•----------------- ---• ----------------- ---------------------- ----------- t � i 4 ---------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State nd.rules and regulations of +he San Joaquin Local Health District. 9 cS Owner and/or Contractor (Signed)- Q` ------------------------------------------------ c7" �' -- - -------- By:---- A -- -------------------(rtle)---- =r------------------------------------ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed'on reverse side). l F FOR DEPARTMENT USE ONLY . + CATION ACCEPTED BY---- -----------------\'"''��. `�------------ -- ----------- DATE APPLICATION REVIEWEDBY------------------------------------- --- --------- - DATE------------------ ' BUILDING PERMIT ISSUED--------------------___________ _. _ DATE----------------- .. ------------------ Alterations - ------------ Alterations and/or recommendations-----= ---------- �'•S =-----------------------••--•--------------------------------------------....._.._. .. -------- i ---------------- --V------- r - - -- --- ---------•------------------------------------- -- 1 � ' -------------- --------------- - -- - --- = -- ---- ------ --------- - --- _-- ---`- FINAL INSPECTION ------------ I ----------- Date I 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 Revised W-2100