10536 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) 1/ a Date Issued ____2 t::____5_____ 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 coTpliance with County,Ordinance No. 549. cl - . �- JOB ADDRESS AND LOCATION------------- --- - ---------4------------------_----- Owner's Name______ __ __t ( � --�Y`-�"-� --- - ------------------0----- --- - - ----- -- --- - Phone- ----------==---------•------------ Address -.i_..... - ---- ----- --------------------------------------------------------------------------------------------------------------- y Contractor's Name----------------- ---L 'Ir h.--- =q i--------------.--------------- •-------- Phone----•--•----------------- -- Installation will serve: Residence ff Apartment House ❑ . Commercial ❑ Trailer Court ❑ Motel ❑ rOther ❑ Number of living units: A----- Number of bedrooms __7_- Number of baths __i____ Lot size ------iS_0--- ______________________ Water Supply: Public system F!r Community system ❑ Private ❑ Depth to Water Tableft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ .Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan I_} " Previous Application Made:-Yes ❑ No.Ell' New Construction: Yes ❑ -No Z/ FHA/VA: Yes ❑ No [+j� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance!from nearesr well__ _---___Distance from foundation__1_____________.M t�riaL__� No. of Compartments________ ._____I.__Size___ ---- ____-Liquid depth_____ _---------------Capacity___ Dispo ai Field: Distance from nearest el!_._. ____-_Distance from fo a n!__ ID Distance to nearest of -J �1C,�'rd 4� f- V Number of lines__________ Length of eae@h ✓tiTie__, '_.Width of trench______ y(�2a----_-------- ----- _______ IVType of filter. material of filter material__ Total length_________ ______________________ Pit: Distance to nearest well____SM _-------Distancrom oundation.... ist n e to nearest 'Number of pits._._________________Lining material_ itm-f Size: Diameter__ ______Depth_____ ----------------------- Cesspool; ___________________.-Cesspool: , Distance from nearest weN_----------------Distance from foundation--------------------Lining material__.________-_______________._-___--_. ❑ Size: Diameter.- Depth b--Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-----.------------------__________.__._._. ❑ Distance to nearest lot n ----- �-------------------------•------------------------------- ---•------------------- -- �} Remodeling and or re airin (describe).__. _--_-j --_--- �e.__. a:.`E %�- ^---k-----••--. o ! -------------------------------•------•-------------------------------- ----- , ------------------------------------------------------•------------------•-•---------------------------------------------------------------------------------•-----------=-------------------------------------------------- --------------------------------------------------------------------•-----------------------------------__-, 7- I herebcertify that have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, /IS+afeaws, d r s a regulations of the San Joaquin local Health pis+ric+. (Signed) --- (Owner and'/or Contractor) By----------------------------------------------------•-------------------------------------------------------------------------------Title)----------------------'------------------------ ------------- - (Plot plan, showing 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------•------------------- F----------------------------- DATE------------- ----- ---------- --------•----- i - --- ------------- --- - --- REVIEWEDBY----------------------------------------- -- ---- --- ----------------------------- DATE BUILDINGPERMIT ISSUED------------------------------ -- - -- ------- ------ -------------------------------------------- DATE----------- - --------------------------------- Alterations and/or recommendations______________________ y ------- f 1 - - - ----• , ------ - - -- - ----- . ,r 4r• _ a _% - C --- �` FINAL INSPECTION BY--------------------------------------+----------- --------•----- 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 1.57 F.P CO. � k