76-36 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. ------ ,h (Complete in Duplicate) Date Issued .._4._M51 Applica4-ion 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. GM JOB ADDRESS AND LOCATION_.1'-L__..y.._ -CK-1- -6---1�. _d_sir,.1 _Y. �.: c?--- :,_ 'I.lrr"h'.s�v's-- ---------------- Owner s Name ------ Phone------------------------------------ /; Address.----'-- �----------------------------- ---------•--------------------------------------------------------•-------------••-•---------------- ---------------•------------------- - � ------ Contractor's Name---- - ----------------- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [9-0ther ❑ Number of living units: ,i Number of bedrooms _ _- - Number of baths ----rl._ Lot size ----_____C �__ __�_`__.______.__.-...---------- Water Supply: Public system ❑ Community system ❑ Private ®Depth to Wafter Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam O'"Clay Loam ❑ Clay ❑ Adobe Dr-Hardpan ❑� Previous Application Made: Yes ❑ No 2 New Construction: Yes ❑ No [PQ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: y Distance from nearest well_________________Distance from foundation--------------------Material----------------------------------.---- ---._. ❑ � �� r / No. of compartments--------------------------Size--------------------------------Liquid depth---------- ---------------Capacity--------------------- Disposal Field: Distance from nearest well-----_----------Distance from foundation---.----------------Distance to nearest lot line------_----_---_ v` ❑ �jji5�'�� Number of lines------------------ ----------------Length of each line-----------------------------.Width of trench.--------------------------------- Type of filter material.----_--._._.-.---- _Depth of filter material----------------------Total length________________._..__._______.__---..---- r � See •ny' Distance to nearest well__�l�.l�-�------Distance from foundation---e _ __..___.Distance to nearest lot line __ ;Mn IJr014tNumberof pits.------ -----------Lining material--- Size: Diameter__ _ .---------Deptn---- - T`'--------------- Cesspool: Distance 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-------- ----------------------- - ----------------------------------------------------------------------------- ----------------------- -- � L -- ----------- _ ' -- _ - - ------------------- Remodeling,and/or repairing (describe): } ----- ------- F " q M---rl�„ t.. -++ ' , ----i7--------------------------------------..------------------ -------`----------•----------------------------•---------•------- ----------•--..._....-----------------------------------------------------'--- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St to laws, and rules and regulations of the San Joaquin Local Health District. , r Owner and or Contractor (Signed. _ S_/ G / . � -� Sy= b �- ---- ------------------------------ (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___ _ _ - ----•------------- DAT ---4�------------------- --------------------------------- REVIEWEDBY----------------------------- - DATE--"'�-------------------------------------------------- BUILDINGPERMIT ISSUED------------ --------------------------------------------------------------------------_ DATE------25r7---------------------------------------------- Alterationsand/or recommendations-------- -- -----------------------------------_-------------------------------------------...-.-..----------------'------•--...-..----------------••---------- ------------------------------------------------ •- ------------------- - - ------------------------•---•-•--------------•--------------------------------- 1L r_- v h.�, 6---- ------------ ------------- ------ ---'--------- -------- FINAL INSPECTION BY:.------ ---------- Date-------(---`-- -- ---- 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 Er-9-2 M 145446 ATWCDfl 12-Sq