3461 - Laserfiche WebLink

Home Browse Search

/ .` APPLICATION FOR SANITATION PERMIT Permit Nq� b_._.--__-- f (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. JOB ADDRESS AND LOCATION--------- �' a$ �Tl f +:1r --------- �r ---------12------------------•------"-------- ----� � Owner's Name---------- ------------------ - -------- f i`t}. r__Y tG./ ----------- Phone---��.'f . Address C4 ' t I ----------------------------•••-----------------•----•---- --•-------------------------------- Contractor's Name---------- - -------- -------------- s.. !! -------------------------------------------- ------------ Phone----7.T7------ Installation will serve: Residence l- Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _/__- Number of bedrooms.?-_ Number of baths ----Z'Lot size -------- --_____-_ Water Supply: Public system ❑ Community system ❑ Private J. Depth to Water Table --- ---- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe K Hardpan ❑ 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 faundation_s -_--______- aterial_____ __L�.___ ______-. p No. of compartments----- ------------------Size_-- -------____-- r .At depfh-444_'*------------Capacity-�--- 'v f sp f i Disposal Field: Distance from nearest well.S'O--------Distance from foundation_�.*F7_______Distance to nearest lot line____ _._... Number of lines-----------Z---------------------Length of each line--- --------Width of trench.--c�y-•---- --------- --- Type of filter material-_1 y!' --_-_Depth of filter material----1_$_'--'_______Total length_.__ _92!______________________ 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-----=- ------------------------------Depth---------------------------- ----------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well---------_. _________________________Distance from nearest building---------------------------------- ------_ ❑ Distance to nearest lot line------------------------------------------------•-•---------------------------- -------------------- ---•-------------------- ----------- -- s i r �. 4 J',r'w► Remod ang and/or re airing (describe)- ---- =fes--,�-x--�--� _G_�=�.�..�.--� -•--"�-�'--•-.�••------•--�----------_-----'----------==------ k tie ,t,,.4.� v� w r- —_ kh ` .,�r..t.E.- or `.tti: -4=-�, ......-----------------�---'--6fat=---=--- _-..�- l._�'=R�'-'----��_--- --------------- -- ---- w - ---____-______-____-__-. At I hereby certify thaA have prep ed this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules a d re ulafions of,W San Joaquin Local Health District. 1r ',S-,i".-------- Oven r Contractor $y:--------------------------------------------------------------------------------- -= ` (Title)-- &Z- (Plot plan, showing size of lot, location of system in relation wells, buildings, c., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------------------- - --- ----- ----------------------------------------------- DATE--------- REVIEWEDBY----------------------------------------------------------- - --------------------------------------------------------- DATE ---------------------------------•-- •-- BUILDING PERMIT ISSN.IED--------------•-------------------------------------------------------------------------------------- DATE------------------------------------- ---------------- Alterations and/or recommendations--------------------------------------------------------------------------------------------------------•----- --•-----•------------------•-•------------------ -------------------------------•--------------------•-------------------------------------------------------------------------------------- ------------------------------------------------------------_--•----------------- -------•---------------------------------------------•----------•-----•------ -------------------------•-------------------------------------------------------------------------------------•------------------------------- ------------------------------------------- -I-----------------•-------'---- ------------------------------------------------------------------------------------------------------------------------------•-------------- ----------•-----------•-------------------------------------` -------------------------------------------------------------------•----- - -------------------------------------------- ----------------------------- FINAL INSPECTION BY:. - Date_2�l__4/S.3------ -- ------------------------------- 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 io-52 Revised W-2100