6386 - Laserfiche WebLink

Home Browse Search

�� APPLICATION FOR SANITATION PERMIT Permit No. _ 1�______________ (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. 544. JOB ADDRESS LOCATION �.7-- -- ----- ------ '. - --------- &---------••------------------------------------------------------ Owner's Name--- .- ------ Phone------------------------------------ Address -------------------------- Address------ (50-00--------- ------i ------ ---------------- ------------------------------------------------------------- � /f Contractor's Name--- --------- ------ -- ----- -- ----`-------------------------------------------------------- Phone�!�AP-2.4---R- Installation will serve: Residence m Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: J_._ Number of bedrooms __ --_._ Number of baths __--_ Lot size ____��0___-___*------1---Z.c±41______-______ Water Supply: Publics stem A—Community system [Private ❑ Depth to Water Table T ft. Y Y Y Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay [] Adobe[ 9p n ❑ Previous Application Made: Yes ❑ No Pb.r.+Htw Construction: Yes ❑ No [ - TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r Septic Tank: Distance from nearest well-----------------Distance from foundation____JA!___.MafVial____ L.,.....- No. of compartments-------Z,„„R----------Size----i4T_1----k_.AQ_-6----Liquid dep}h---L�-'�,--------Capacity_��-------- Disposal Field: Distance from nearesttt well..............__Distance from foundation____I*-_�___...Distance to nearest lot line..._!aJ.__-____. Number of lines__.___/______ _ Length of each line_____7_0_-.--------------Width of trench.__�4______ ________________ h �q Type of filter mate rial_-�_.4- Depth of filter material----.1�---------Total length-------V-_7__________________--__._ Seepage Pit: Distance to nearest well- ------ Distance/ om�fo�ndation__ Q__�____.Distance to nearest lot line__1-a i___- Number of pits------I-------_____Lining material__1A __ __-Size: Diameter__2_C------------Depth-_._�Q__#_________________ 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---------------------------------------------------------------------------------------------------------------------------------------------- Remo eling and/or repairing (describe):- ----------s--- -- - CO-----------•----------------------•-------- = �y - = ------------------- ---------------------------------•----------------------------------------------------...--•---------•-----••---•---------------•-----------------------•-------••----•--------•------------------------- 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)---Isowingg - --- -- --- ----------------------- ----------------------------- Contractor] Tale - rilll+�s•�••• .------ --- ( } -------------- By. r (Plot piansize of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). 1 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- --------- - - ------------- --------------- DATE.--------.�------------------------------------------- G " REVIEWED BY-------------------------------- - - -- - -- ----- ------------------- ----- ---------------------------------------- - DATE----- --------- --- --------- --------------- BUILDING PERMIT ISSUED - DATE ------ -------- - --------- Alterations and/or recommendations:------------------- ----------------------------------- ------------•-••-----•-•-------__ --- p- e ------------•------------------- I ` S Ad �---•--------------- - - ---------------------- _---- ---- - ---r- ---•-----....� � FINAL INSPECTION BY:_____L G� --------- Date........ ... ....--------- ' .S � - - --- -------------------- 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 E5-9-2M 145446 ATW00D 12.54