2812 - Laserfiche WebLink

Home Browse Search

S ;'z •tom . moi. G . �� j _ -8_s- APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued _ _ '_-''__ l 32_—oSo _t p _Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein desdribed. This application is made in compliance with County Ordinance No. 549. w JOB ADDRESS AND LOCATION---A_- ---way---between,-- l; g ----9----H_jr—;;_ay--�-- -------- Owner's Name -i - ,pusinessroute on i r onRdo -- Oa .L n0 . --- -- --- ----- -- --- -- r 7Wi n Address---------------- a :_._� ------------------------------------------------------------- Contractor's Name--------=- -Dai ------------- - ----- --- ------ Phone----'_-ter --------------- -- ---------------------------------------------- --- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Mot-el ❑ Other ❑;raes .:6`; Number of living units: Number of bedrooms ___p Number of baths __2___ Lot sizez'£�S -------------------------------- N._ Water Supply: Public system ❑ Community system ❑ Private © Depth to Water Table _40- ft. , Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobes] Hardpan ❑ Previous Application Made: Yes ❑ No 0 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-------j_0_1---Distance from foundation------- t-------.Material----- --------- q No. of Compartments-----Z------------------Size---5--x4--A-4---------Liquid depth----- ...........Capacity---L--&---------- Disposal Field: Distance from nearest well------------------Distance from foundation--------------------Distance to nearest lot line______________•__ ❑ Number of lines-----------------------------------Length of each line------------------------------Width of french----------------------------------- Type of filter material-------------------------Depth of filter material-----------------------Total length_____________--_-_----_-_______________ Seepage Pit: Distance to nearest welld�P,�tDistance from foundation----1-'_!--------Distance to nearest lot line------ _!_-____- Q Number of pits_-___1___-____-____Lining material__-_ _ _C_jL_____Size: Diameter_.___.4_&t_-___-___Depth______-_" O_t..____ 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----------------------------------------------- -------------------------------------------------------------- ----------------------------- Remodelingand/or repairing (describe):-------1,_ew----------------------------------------------------------------------------------------------------------------- ...------------------ ---------- --------------------------------------------------------------------•------ ----------•---------•--------••-•----------------------------------------------------------------------------------------------•------------- --------------------------------------------------------•------------------------------------------------------------------------------------------------ ------------------------------------------------------------------- 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)-------------------------------D!:,Ata------------------------- (Owner and/or Contractor). W c. ___sr_ ..._St��u__ D -----------------------------------------------------Title----- �w` ,,,v_-_-.t-_-•._^__ ____________________________ (Plot plan, showing size of lot, location of sys em in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED -A--------- - ------------------ DATE_ f REVIEWEDBY------------------------------------------------------------------------------------------------------------------------------ DATE-------------------- ------ BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- Alterationsand/or recommendations------------------------------------------------ ------------------------------- ----------•---------------•------------------------------------- --------- -----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•----------------------- ------------------------------------•-------------•---------------------------------------------------------------------------------------_-----------_-------------------- ----------------------------_-------------------- -----------------------------------------------------•---•--------------------------------------------------------------------------------------------------- -•-------- --•---------------------------------------- ----------------- ------------------------------ ---------------------------------- -------- ---------------- --, FINAL INSPECTION BY:_ .__..;�''�`- gin' _::. .,rt _t_._.. Date 'y 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 I ES-9-2M B-51 Revised W-2400