6536 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. ------!-S-.. (Complete in Duplicate) 7/� Date Issued --------------- ------ 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 in compliance with County Ordinance No. 5`499.. JOB ADDRESS AND LOCATION-- ----------- 3 3 I d-..-. LJG't'cJ" -----•---•----------------- OwnersName------ ! . -- ��n _ - ------------------------------------------------------------------ Phone----------------------------------- Address ``---,---.. .... ----•--- -------------------------------------------------.---------.------------------------- ----•---•-----•------------- Contractor's Name N' C 1 �1 `!fes S d /�, --------- Phone-- .g---- ' `�9� Installation will serve: :Residence & Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ 1 Number of living units: J----- Number of bedrooms -2-_. Number of baths ---/--- Lot size ------90------ ------------------- ---------- Water Supply: Public system [)a Community system ❑ Private ❑ Depth to Water Table'`__ ft. ' Charac+er of soil to a.depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: , (No septic +anVor cesspool permitted if public sewer is available within 200 feet.) Septic Tank- i nce from nearest well-----------------Distance from foundatiors--------------------Material----------.-----_-.-T.-= -_---------------. N of compartments-------------- -----------Size------•-------- ---------------Liquid depth-.---------- - ---------Capacity----------------------- F Disposal field: s a�jce from nearest well------------------ from foundation-----..-------------Distance to nearest lot line_-----_---.----_- NOPI. uer of lines-------------------------.---------;Length of each line------------------------------Width of french----------------------------------- Type of filter material-------------------------Depth of filter material-----------------------Total length-----------------------.-_--_-------__---- Seepage Pit:" Distance-to nearest weli____ Distance from fouodatyr-----tA----------Distapge to nearest lot line------ _-_.-__- [X Nu'mher of pits---------)-----------Lining material--C- --�11.[Fti Diameter----s- -----------Depth-- 42 '0------------------- (' Cesspool: Distance from nearest well-----------------Distance from foundation._.__._____.------.Lining material-------------------_"--"- _-"-----. "� r ❑ Size: Diameter--------------------------------------Depth------------------------------ -- - ----------------Li91-uid."Capacity---------------------==- gals. �1 Privy: Distance from nearest well-------------------------------------------------- from nearest building------------------------------------------ ❑-. Distance to nearest lot line--- ------------------------------------------------------"----------------------------------------------------------------------------------- Remodeling and/or repairing (describe):--------------------- ------------------• ------------------------".......•--•----•-----------•---------------------------•----•-•---•----.----------•- ------------•----------------•-•------ -----------•------------- -------------•---------- --------------------------- --------------------- - ----------k----------- -------------------------------------------------------------------------I---------__-._---___----______-.-_-__-_--------_-----"-__------------_-_--------_-----_.--------------_----_.--_____-----_-_ 4 I hereby certify'thatl have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State/laws, and rules and regula ions of the San Joaquin Local Health District. , O ------------------------------------- ---. (Own and/or Contractor)(Signer} -------------------------- ------ 1 ---------- (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.._.- _.._ ��g REVIEWED BY-------------------------------------------------------- --------- - ---------------------------------------- DATE-----------•--�-----+---`-3 `-.� BUILDINGPERMIT ISSUED----------------------------------------------- ---------- -------------- ---------- ------ DATE----------------------------------------------------------- Alterationsand/or recommendations------------------------------ --- ---------------------------------•---------------------------..:.-------------------- --------------------------------- - ----------------- -------•-------------------------------•----'-----------------------------------------------------------------•---------------------------•-----------------------•-----------------------------------•--- --------------- ---------------------•'-------------------------------------------------------------------------------------•-----------------------------------------------•-------------------------------------- ----------••--------------•---- ----- ---------- - •------------•-' -- --------- --- �} C Y Date--.7)-------- FINAL INSPECTION -----r--------J------------------------------------- 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 ES-9--2M Revised W-2100 ry