2353 - Laserfiche WebLink

Home Browse Search

6 APPLICATION FOR SANITATION PERMIT Permit (Complete in Duplicate) Date Issued Application 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. q JOS ADDRESS AND LOCATION---------4a5____6------Los__Ail eles .e ---�`�--t-0_C-_kt Ori,---0- _ i ----------- ----------------------------------- ---- Owner's Name--------C '---------------------------------------------------------- ------------------ PhoneT --------------- Address------------------ $c a@ -----------•---•------------------------- ------------------------------------------•------------------------------------------------ ---------------------------- Contractor's Name-----------e1. 8-------------------=--=---------------------------------------------------------------------------------- ------ Phone------- x €57------------ P fnstallation will serve: Residence EN Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel L] Other ❑ Number of living units: _____- Number of bedrooms Number of baths _______ Lot size _____� -X _GG-------------------------------------- Wafer ________ -- Water Supply: Public system DX Community system '❑ Private ❑ Depth to Water Table-------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ -Sandy Loam ❑ Clay Loam ❑ Clayf] Adobe ❑ Hardpan ❑ s' Previous Application Made: Yes ❑ No k] New Construction: Yes ] No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) - Septic Tank: Distance from nearest well------------ Distance from foundation______ ...........Material-----C_e71ten --tti-4-tCli________. ]i[] No. of compartments------------------2-----Size--:4�'-x6_1-x4..--------Liquid depth-�-1-_&-3-1------------Capaci#Y--.8Q0------------ Disposal Field: Distance from nearest well__________ ______Distance from foundation--------------------Distance to nearest lot line___-__--________ ----------Length of each line------------------------------Width of trench----------------------------------- ❑ Number of lines________-_____________ g , Type of filter material-------------------------Depth of filter material-:-.-___________.____Total length--------------------.________-5;___.___ 4 Seepage Pit: Distance to nearest well_ ----------------Distance from Toundation-__S�__------------Distalnce to nearest lot:iine_______.._______ . i ® Number of pits---------------1-----Lining material___br> Cit.....Size: Diameter_____d. ___-____.Depth________23 1--__-----______ Cesspool: _ _ Distance from nearest well --------- ,Distance frfrom foundation------------------ �ir ing material __ --------------------- als. SizeDiameter-=-- ------- Depth--- ------- � - , Privy: Distance from nearest well_------------------------------------------------Distance from nearest building------------.--------------.___________- ❑ Distance to nearest lot line---------------------------------------------------------------------------------------------------------------------------------------------- F Remodeling and/or repairing (describe)------------------Ins_talling 2-ce111D_ement--br' Ck--se t-�C___ a_nk___and-__ I hooking-_-up_--t°- the---vet -c&.l__•drein_- ,rzth_- tea-- it-=----°f _ od---orne_-bzzz ---------------- -------------------------------------------------------------------•------------------------------------------------------------------------- --------------------------------------------------------------------------- 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 rules and regulations of the San Joaquin Local Health District.- (Signed)---------------------- istrict.- (Signed)---------------------= Delta �/�7 (Owner and/or Contractor) i ----- By:------------------------------------Jx' 'y 411- T`-tY1P l f__/ L✓ • --------------(Title)------------)Wn-er--1�-gT-•------------------{---- (Piot plan, showing size of lot, location of system in r tion to wel s, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY DATE--------- ------------------------------------- ` REVIEWED BY----------=------------------------ ---------------------=--------------------------- -------------------------- DATE---- �------------------------- BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE-------- ;. Alte ati s and/or recommendations:_____ _ _---_ �- ---------------------- �. -- - ----------------- ---------------------------------------------------------- - 7------------------------ ----- --------,--- i FINAL INSPECTION BY:___- '- ---------------------- Date-_-------------- � ;; ---------------------- SAN JOAQUIN-LOCAL HEALTH DISTRICT ' r - 'x 130 South American Streef 300 Wes+ Oak Sfreef 132 Sycamore Street 814 North "C" StreetF g Stockton, California Lodi, California Manteca, California -- 'Tracy, California k ES-9-2M 8-51''Revised W-2wo