5846 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. �`?`--la (Complete in Duplicate) w � _ pate Issuec�� ._/�:__�-'`.•_w� Applica}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 incompliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION. -- '1-40 ---7------------- --------------------------•---•-------------------- ---------------- Owner's Name------------ t{ht-1 I ..-------S- 7—ahr-'S------------------------------------------------------------- Phonel% Address r �- - - - ---------- Contractor's Name______________________ -- - ---- ` Phone':_=_!G'��,%/ Installation will serve: 'Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __/____ Number of bedrooms :1� Number of baths __1____ Lot size __X-- - i.__;�_j-__________-____-- Water 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 Hardpan ❑ Previous Application Made: Yes E No$d 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.,,71 xl�istance from foundational%_ --------- Material ----- __ ___ _ ---------------- No. ________ -_- No. of. compartments_____Z-br_Li uid de h..T -_.____ ___Capacity_ Q_ l / Disposal Field: Distance from nearest wellrr�%�i ��Distance from foundation_ __.___Distance to nearest lot line_47__f-___ Number of lines______ l_? -... -_ - Length of each line___,,2.,,t�`_ - Width of french .___"P`________________._ Type of filter material_____�°f Depth of filter material--�__.__Total length___,'__________________ r Seepage Pit: Distance fo nearest well _Distance from foundation_i�.__.-..Distance to nearest lolt line__/4........ Number of Lining materia[_-_�_ + r ..a��__.__-____.Depth_._ ' pits.��-�_ 1 ___! ____'�5ize: Diameter.._f__d__r ________________ \ ` Cesspool: Distance from nearest well ----------------- Distance from foundation ------------------- .Lining material ------ .___-_---_--_._______________. El Size: Diameter--- =---- -------------------- Depth--- ----------------------- -- ----------------------Liquid Capacity ---------------------------- gals. Privy:E Distance from nearest well ---------------- .--------------------------------- Distance from nearest building_____________________________ ❑ -- +- Distance to nearest lot line---------------------------------------------- Remodeling and/or repairing (describe):__ ---------------------------------- -------------------------------- A ---------------------------- r - -----..--»_ T ..`---•-------------------------------------- ;-------------------------------------- •-- --- - ---- ----------t'- ----------------------------------------------------».---------------------------------------------------------------------------------- I hereby certify -that l have pred this application and that the work will be done in accordance with San Joaquin County 1 ordinances, State laws' -and rule£ nd , gulations of a San Joaqu' ocal Health District. --------------------------� --- --- i --- ----- ----- -- ------ --- ,. [Signed)- ---------------- [Owner•a%n or Contractor) sy:... --- --- - --- -------------- -•---------(Title) ..... - _�-------- [Plot plan, showing sizo lot; location of system in relation to wells, buildings, etc., can be pla ed on reverse side). FOR -DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------------------ - ---- -------------------------------------------------------------------- DATE-------- -- REVIEWED BY--------- - ___... DATI= ;Z7 _ -----------------------------------•----•----- --------•-•---•--------------:--- BUILDING PERMIT ISSUED -------------------------- --- -- -------------•-------------------------------------------------• DATE..-------------- ---. Alterations and/or recommendations------------------ \- -, ------••--•-------------------------------------------------------------• � t --------------•--....----•---------------------------------------------=----------------------•---...._.----•------------------------------------------------------------•- ---•-••------------------------ -----------------------------•---------.--------- _---- - - - - -- - - - - ---------------------------------- - - - - -- - - ---------------------------------------------- - - - - -- - - - ---------------------------- - - - - - . FINAL. INSPECTION BY:__ -- 11 ` ---------------------------- - Date--- ............. ------ ---------- --------- SAN JOAQUIN LOCAL HEALTH DISTRICT 134 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California, ES --9--2M ; - Revised W-2100