6359 - Laserfiche WebLink

Home Browse Search

".0 APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued 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 N 549. JOB ADDRESS A23 LOCAJION--- ----- *40 Owner's --------------I........ Phone--- Address ------------------'7------------------------------------------ .... ------------------------- ;Name__6_�jPhone - ----------- ;�- ---------------------- -------------------------------- K Installation will serve: Residence A—.4,partment House ❑ Commercial Lj Trailer Court [I Motel L] Other L) Number of living units: _1---- Number of bedrooms Number of bathSIL Lot size Water Supply: Public system [j Community system [I Private �Ilepfh to Water Table//&ft. Character of sail to a depth of 3 feet. Sand [-] Gravel E] Sandy Loam E] Adobe Clay Loam n Clay E] Ad Hardpan E] Previous Application Made: Yes E] No �lew Construction: Yes 4—uQ-R TYPE OF INSTALLATION AND SPECIFICATIONS: (No'septic tank or cesspool permitted if public sewer is availa6le within 200 feet.) Septic Sepf' Tank: Distance from nearest well--.'X Distance from foundation----e/ "----Mate riai_--d!koo._.---coojr.Aeo;6L _� No. of compartments------02- - ----------S ize-,61—a X//-40------Liquid depfh_4L_j—------- --------Capacify_/_A_#_.Q_,____ Disposal Field: Distance from, nearest weil----7-T.....Distance from foundation---j-49.........Distance to nearest lot line___,M__ Number of lines---------- .......Length of each line--------�-----------.Width of trench ff ----?--4-------------------------- Type of filter material--- --------- ----Depth of filter material-------- r......-Total length-------- ---------------- I Seepage Pit: Distance to nearest well_1.490!------Distance om fopndation---0-10------ Distance to nearest ]of line__/q__* Number of pifs....../ ----------Lining material_,,8$-_-_44--'-.Size: Diameter-_,7,7------__Depth--..2-0 -_____-_.___-__ Cesspool: Distance from nearest well_____________._-_Distance from foundation_-_._..__-----_-.1-ining material______-__-_-_----__.__.___-__________- G_ ❑ aterial-- ---------------------------------- LI Size: Diameter---------------- ----------- ----------Depth-- --------------------------__ -----------------Liquid Capacity------.--------------------gals. Privy: Distance from nearest well.-____--- ----------------------------I ---------------------------- ...Distance from nearest building._-___.-__.______________________________ ❑ Distance to nearest lot line. - ----------------••------------------------------------------ ------------------------------------------- Remodeling and/or repairing (describe):------- ----------------------------- - ------------------------------------------------------- ----------------------------------------------------------------------------------------------------- ----------------------------------------------------------- ------------------_------------------------------ ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------ ---------------------------- --------------------------------------------------------- ---------- - - --- -- -- ------ - --- ------ I hereby certify that I have prepared this application and that the work will--be donein-accordance_*w_i_fh_.-SanJ_oa*quin---County - ordinances. State laws, and rules and regulation, of the San Joaquin Local Health District. (Signed)--- --- -- - -- ---- -- ------- --- --------- - ---- --------------- -------------------------------------------- Contractor) . r By:-- -W---- 1-7- - --------------------------------------------------------------- (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---- . -------- -- --------------------------------------------------------------- DATE------ - - ----------------------------------------- REVIEWED BY--------------------- ---- ----------------- ---------------------------------------- DATE__.-.------- -----•- BUILDING ---------------------------- BUILDING PERMIT ISSUED------------------------------- --------- ---------------------------------------------------- DATE.--------------------- Alterations and/or recommendations:----------:------- ___ _t.3-------- ----------------------------------- - ----------------------------------- -------------------------- ----------- ------ ------------ -------------------------------------------------------------------------- -- ---------------------- --------------------------------------------------------- -- ------- ---------------------------------------------------------------- ---------------------------_---------------------------------------------------- ------------------------------------ - - ----- ------------------------------ ---------------------------------- ------------------------------- ------- --------------------------------------------------------------------- --------------------------- ---------- ------------------ -------------------------------------------------- ------- ---------------------- -------------------------------- --------------------- 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 E5-9-2M 145446 AT WOOS i2-5a