9109 - Laserfiche WebLink

Home Browse Search

APPLICA ION FOR SANITATION PERMIT Permit No. .___.?Z- _!�.__•. (Complete in Duplicate) b-41 - Date Issued Applica{ion is hereby made to the San Joaquin Local Health District foraermit to construct This application is made in compliance with County Ordinance No. 549, p o struct and install the work herein described. JOB ADDRESS AND LOTION. :.___ Owner's Name---- = -= t-----tett-- Phon � � 3 --------- --------- ' - - --------•----------- Address--------------------- _ka m: -----------------------------------------------------------.---•-------------------------------------------------- -------------------------- -----_/-------- ContractorsName r- ..� --------- - --------------------------------------------•-------------------------------- Phone Installation will serve: Residence JZ"'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other E]r J ` Number of living units. ._____ Number of bedrooms __ Number of baths __ _.__ Lot size _... --•--------•------ WaterSupply: Public system [2__'Community system ❑ Private E] Depth to Water Table it. Character of soil to a depth of 3 feet: Sand Gravel Sand Loam Clay Loam Clay p f ❑ ❑ Y ❑ Y ❑ y ❑ Adobe Hardpan ❑ Previous Application Made: Yes [❑ No New Construction: Yes Q/No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) %�� Distance from nearest well_________________Distance from foundation__________.___.___.Material_____-._______.________--_._______.__..____.... .,No. of compartments Size ------------Liquid depth--------------------------Capacity----------------------- Disposal°Fi Distance from nearest well_________________Distance from foundation--------------------Distance to nearest lot line____---_____--._- Number of lines--------------------- -- --------Length of each line---------------------' Width of trench Type of filter material.........................Depth of filter materia!----------__ - Total length__.-_.__.____________-______.__ Seepa Pit: Distari e to nearest well_.+S----- -------Distance from foundation__j�.___________ .,Distance to Weare o _--_-_-__-�---,- Number of pits------I--------------Lining material---:-------------------Size. Diameter--------3.b_.........Depth-- =,.... .1------ Cesspool: Distance from nearest well_________________Distance from foundation------------------- Lining material-----_._-----._________ ❑ Size: Diameter-------------------------------- ----Depth--------------------------------'------------------Liquid Capacity--- -----gals. rivy: . 'Distance from'nearest well-------------------------------- ---------------__Distance from nearest buildin ❑ Distance to nearest lot line--------------- g I Cb Remodeling and/or repairing (describe)---------- --------------------- ------- �-� -e ---U-------------- --------------------•-----------------•---•------------------------------- ------------------•-------------------------------------•-----------•------------------------------------ -----------------------------------------------------------------•---------------= '- --•------------------- •------------------------------------------------------ --•---------•---•-------------------------------- I herebycertify 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------- ------------------------------------ r --------- -- - � � ----��---- Wer and/or Contractor) r BY:-----•------- -• • -- 4 -- �,, �----------------------- ------ �4'(Plot plan, showing size of t, location of system in relation to wells, buildings, etc., can b'eleplac d� on r�rerse side). 2 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - -------------- -------------- DATE •-- r I REVIEWED BY DATE--.,-- -7L ,�-- UILDING PERMIT ISSUED-----------------'-'-- ---- __-- .-- - ___ DATE.-------- -----'------•----'-- -- - ------------------------- Alter ion an r e ammendations ------ /f- -- - -- { --- - -- r- • ------- r - - F1NAL INSPECTION BY:..--"r-- .__�---•C�� Date ' ' - ' . y. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South Americen Street 300 West Oak Street 132 Sycamore Sfreef $14 North "C" Street Stockton, Celifornie Lodi, California Manteca, California Tracy, California ES-9 745446 ATWOLL,