4808 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. .. (Complete in Duplicate) Date issued ___ ___ _____-+ Applica¢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 ith County Ordinance No. 549. • 1 � i oA JOB ADDRESS AND LOCATION----____-- -T-•---- ` '---. - *--------- �.---•------------ Owner's Name--------------------r----------------- Q_-QI-�•-4--------�-•----F!"If Q l�^� n �----------------------- Phone_rn-4-' ----�.,�-��.� Address-- +t-I �`.- R-�4 - - 'al-lei *04-1----cp,a-d-- --- -......--------- Contractor's Name------------------------------------- C1 e1�-�-------�� - -------------------------------------------------------- Phone... o2r� f-6 Q-7_•------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---I---- Number of bedrooms "✓ Number of baths ----L Lot size -----------I--- ---------------------- Water Supply: Public system ❑ Community system ❑ Private 4 Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe, , Hardpan ❑ Previous Application Made: Yes [❑ No 9--- New Construction: Yes ❑ No ❑ C1w/epx c'�'AM zey J7 y� TYPE OF INSTALLATION AND SPECIFICATIONS: V a}+� (No septic tank or cesspool permitted if public sewer is available within 200 feet.) c T Distance from nearest weal-----------------Distance from foundation....................Material-----------------------------.._--_-.-._--------. ,rR.w9 No. of compartments----------------------Size-----------------------•---.-..Liquid �pth--------------------------Capacity----------------------- os Id: Distance from nearest well_,a '&__-_-Distance from foundation__-_ Distance to nearest lot hfe-__--5-....- �''� Number of lines-------/--------yIi_. Length of each line_jb__"_. `� .Width of trenchoz5i_____ • Type o� filter materral.___f y__.R ._Depth of filter material____ _.__ 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___... De th Li uid Capacitygals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----------------------.-.----------.-._.- ❑ Distance to nearest lot line----------------------------------------------------------------------- .---------------..---------------------------------------------------- Remodelingand/or repairing (describe):------ -------------------------------------------------------• ---------------------_---------------------..........--•------------------- ------- -------------------------------------------------------------••------------•-----------------------------------------------------------------•---------------------------------------•--------------------------------------- ---------•----------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------ ---------------------------------------------------- ----------•----•------------•---- ------. --------------------------------------------------------....-------------------------------- I hereby certify that prepare applicati a d t at the work will be done in accordance with San Joaquin County ordinances, State laws, and r e and reguiat n` f +he J quip Local Health District. (Signed)•---•-_--------------- ---- --- - ----------- - - ----- ----- -------------------- Contractor) By:-------------------------------------------------------------------------------------------- - --- -----------(Title)--- F.hi2f .10 '---------------------- (Plot plan, showing size of lot, location of system in relation to ells, buildings, , can be placed on reverse side). FOR DEPA TMENT USE ONLY APPLICATION ACCEPTED BY------ -------------•---- -----------------------•---------------- DATE-- •- -------------------------- REVIEWED BY---------------------------------------- --- ------------- -------------------------------------------- DATE- �" .. ... BUILDINGPERMIT ISSUED------------- ------------------------------------------------------- DATE---------------------------------------------------------•- Alterationsand/or recommendations:----------.-------- ------------------------------------------------------------------------------------------------------------------•----------------------- -----------------------•------------------ -------------- -•----- ------ - ------------------------------..------------------------------------------------------------------------------- ----------- -------------- FINAL INSPECTION BY: Dae.._y `-�j.�� d SAN JOAQUIN LOCAL HEALTH DIS �7 T 130 South American Street 300 West Oak Street 132 Sycamore Sfreef 914 North "C" Sfreef Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised W-2100