4319 - Laserfiche WebLink

Home Browse Search

46% APPLICATION FOR SANITATION PERMIT Permit No., ---�f.... --- --- (Complete in Dupli :ate) Date issued --- ! Z�—CCU -o6 Application is hereby made to the San Joaquin Local Health District for a permit to_construct and install the work herein des ribed. This application is,made. in compliance with,County Ordinance No. 549-1 , Sic e 014 l[75 - M04-e��,O S.'7— ` i / J �/ �/' JOB ADDRESS AND LOCATIO -.-- 1 _ ' . _-0. ?�`r__.r/_�- I----7_- �------/Y_�-----d--- w�'>!'J2— -- dOwner's Name------------•--------------- - ---D'�--- --G-` .-. -•--------- , - -- ' ' ---- ---- -,-,-�--- - -------------- Phone----•------------------------- - - Address-----------------•--- -----------i�d .�------- 8 : '� - i Contractor's Name--------- -------- - ----------------------------------------------------------- Phone----------------------------------- Installation --------------------- ---Installation will serve- Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court [❑ Mot l ❑y�//Other Number of living units: -l____ Number of bedrooms .-/--,Number of baths ________ Lot size ____ _..___._____moi--___ ,l__ _______________ a r Wafer Supply: Public system ❑ Community system ❑ 'Private Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ . Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe A Hardpan ❑ � Previous Application Made: Yes ❑ No N New Construction:; Yes 4 No ❑ 4$ 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_'R._t Distan a ron foundation _Q_ 71�.dvlat iaL___. �/'____ ___ ____ _____f ,� ' f No. of com artments_____A- ----._ Size_ , _ _S ___Liquid de th_____ _ -Capacity_ ------ 74 __ P !-. G p. p Y A Disposal Field: Distance from nearest-w Il__��___'-.Distance from foundation- _�._ Distance to nearest lot line___��! ---- _i ____._._._.Width of french._______. �J Number of lines____+___�_�_______ _____ ___Length of each line________ i �- ��. ® - - Type of filter material__cz. Depth of filter material____/-�---;-__-.Total length___.____.___ Seepage Pit: Distance to nearest well________________-____Distance from foundation____________..' ___.Distance-to nearest lot line__.:._--.____-_ ❑ Number of pits----------------------Lining material--_-------------------Size: Diameter----------------------.Depth---------------------------------- Cesspool: ------ ,__,------------------ , Cesspool: Distance from nearest well----------------- from foundation----_._.._-_'.___.Lining material------------------------------ Size: ____________________ ` ❑ Size: Diameter------------------ -------- ----------Depth----------------- --------•------- :----------Liquid Capacity----------:-----------------gals o Privy: Distance from nearest well___________________________.______....._____._._Distance from nearest building------------------------------------------ ❑ Distance to nearest lot-line--------------------_________---------------------------------------------------------- -' Remodeling and/or repairing//�describe:__*___C9�y' ------- ----------- --- - Sy-O_,e:--------- ---- �P_......- ¢- --- 1 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 Disfricf. t� ' �" ' ------------------- Owner and/or Contractor) BY:---------- t -C ---------------------- ------------ ------- --------------------- (Title) {Plot plan, showing size of lot, location of system in relafion to wells,.buildings, etc., can be placed on reverse side}. I IV ' f FODEPARTM ENT USE ONLY APPLICATION+ACCEPTED BY.------- -------------------------------------------------------- DATE------ . ---------------- REVIEWEDBY------------------------------------ ------------------------------------------------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED--------------------------=---------------------------------------=----------------------------------- DATE------------------------------------------------------------ Alterationsand/or recommendations:------------------ -- ----=-------- ---- ---------------------------------------------------------------•-----•----------------------------•-------------- -- --- --- ------- ------------------ ---------- -�------- ------------------------- ----- ------- ."t r--� � --_...__•------------------- cJs.,.C�....� '-'•'��'- '- -- '-"•' "'----------------------------------- -------'•--------------------------------- ----------------------------------•-------------- ---------------------------------------------_--------------------- - -- ---- ------------ 0210W. FINAL INSPECTION BY---------------___ � Date------ .-.'4�-'--- -'- 4- 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- M-lo•s2_Rovised W-2100