2995 - Laserfiche WebLink

Home Browse Search

� b APPLICATION FOR SANITATION PERMIT Permit No. .__...- 9 (Complete in Duplicate) - Date Issued -q-------__=---- I Application" ereby 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. 599. r JOB ADDRESS AND LOCATiON_.2_5_-yA-P<f___ -_____ ________ _____----- ----------- ----------------------------------------------- Owner's Name---------------------------------- - ------------- 0 ks--------------------------------------------------- C ) PPhhoonnee---- Address - � te: - ------------- -----------------------------•--------- `---- -------F---a---------------- I ------ Contractor's Name--.- -- • - Installation will serve: ResidenA artme.nt Ho ler Court ❑ Motel ❑ Other ❑ Number of living units: _j----- Number of bedrooms _-a''Number of baths I--- Lot size ___6-Q-/_X------. -_�--_---_--_-. Water Supply: Public system X Community system ❑ Private ❑ Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeJK Hardpan ❑ Previous Application Made: Yes ❑ NoX Now Construction: Yes ❑ No ❑ G �tr , „w' ( , �v'l1�1C ...rCr�Cy TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Ta k: Distance from nearest well-----------------Distance from foundation-------------------Material-_----------______--------------------__------. No. of compartments--------------------------Size---.-----------------------------Liquid depth--------------------------Capacity---•------------------- Disposal Field: Distance from nearest well------------------Distance from foundation--------------------Distance to nearest lot line-------______-_-• �} Number of lines-----------------------------------Length of each line------------------------------Width of trench----------------------------------- I Type of filter material-------------------------Depth of filter material-----------._-----------Total length------------------------------------------ Seepage Pit: Distance to nearest ' well-P0-------G------Distance rfoundaio �-----------.Distance to nearest lot Number of pits----_ Lining material__ -- 60__0U145__Size: Diameter-- 0--- -------Depth--_-Aline------------_-___--_ Cesspool: material -. a Distance from nearest well from foundation--------------,_-.-.Lining material----__-_----_---------_-____-____----. ❑ Size: Diameter--------------------------------------Depth-----------•----•-----------------------------------Liquid Capacity---------.------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----_----_----_-____----___-----------.--. i ❑ Distance to nearest lot line---------------- Remodeling ----Remodeling and/or repairing (describe): ----------------------------------------------------------------------------------------------- ---------------------------------�� --------------------------------•----------------------------•-----•---•------•---------------- ------------------------------•---•-----------------•----------------------------------------------------------------------- (� . ---------------------------------------------• --•-----------------•---------•----------------------•----•---------------------------•---------------•-------------------------------------------------------------------- /rham -------------------------------------------------------------•------------------- --- --------------------------------------------------------------------------------------------------------•----------------------------- v hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin CJ ounty ordinances, State laws, and u s and regulations oiNthe San Joaquin Local Health District. "r' I (Signed) ---------- = I ------ ------ -------------------------------------(2Wmvrxar*=r. Contractor) ,} Y� = = ---------ITitle)---- -�I I- �'�'- ' (Plot plan, J.2n�gg size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side]. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -------- ----- - -- - ----- DATE REVIEWED BY -`-- 4 -------- -------------- DATE -f _ �'`��-------Z1 '---- BUILDING PERMIT ISSUED-------------- 'fF DATE `- --j------)-•---------- Alterations and/or recommendations:--- ------- ------------------------------------------------------------------------------------------------------------=---------- -------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------- ---------- FINAL INSPECTION BY------------------U_j___V-------4 Date------- -:lr --- - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Stree+ Stockton. California Lodi, California Manteca, California Tracy, California ES--9--2M 8-51 Revised W-2100