7048 - Laserfiche WebLink

Home Browse Search

�AD 4 APPLICATION FOR SANITATION PERMIT Permit No. ... Q.. {C amplete in Duplicate) � Date Issued Appliceion 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. JOB ADDRESS AND LOCATION--------------------7-A-9I ...Ak` Owner's Name---------------------------------------R,... ........w-k Te'll--•------------------ ----------------------------- ....... Phone------------------------------------ Address Contractor's Name "*' Phone-------- Installation will serve: Residence 0� Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ -Number of living units: -------- Number of bedrooms _3--- Number of baths A_- Lot size --------.r-Q---..--y__VJ0------------------- Water Supply: Public system P� 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 ❑ NoNew Construction: Yes No ❑ ti TYPEIOF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well------4-----Distance from foundation.----1-------.-.Material_.._-_----�/Ir!-or" ! No, of compartments...------.Z - - - ---Size---- -----Liquid depth---------4%"M-----.-Capacity-•-----ql*g--�--�.1 Disposal Field: Distance from nearest well------ �1[(k Distance from foundation------j _........Distance to nearest lot line_-_._.�-...__. Number oflines---------------H-_------------Length of each line---12- -A�Wl Width of trench------- ----------------- ` Type or filter material...-- . ....Depth of filter material......- __-`_._-...Total length.__---.�Q------------------ --` �! Seepage Pit: Distance to nearest well.......A---------Distance f om foundation----�.p._--------Distance to nearest lot line----- Number of of its.---- Lining material------ ----:Size: Diameter-__... �-�F_._-- Depth......-_... _�--- Cesspool: Distance from nearest well ................Distance from foundation--------------------Lining material-----._.----------.----------_-------- ❑ Size: Diameter------ -------------- ---------Dept h----------------------------- ----------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building____----...-_.---------_-_---------_----- {� ❑ Distance to nearest lot fine------------ - ---- ---------------------------------------------- Remodeling -------•---- :-----------•---------------- Remodeling and/or repairing (describe):-------------------------------------- ---------------------•--------------••-•--------•------- --•--••------------------------•------------•--•----------------------------•-------------------------------------- ---•.------------- •--------------•--•--------------------------•-------•---•-------•------------------ -------------------------------------- -------------- ----------------------------------------------------------------------•------------------------------------------------------------------------------------ ----------- -- -------------------•-----------------------•• --- ...... -------•-----------------••--------•---------•---------------•---•------------------------------------------------------•-------------------------------- 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. a _- (Signed) ' 1. ... ----------- (Owner and/or Contractor) By:------------------------- ----------------------------------------------,---------------------------------(Title)------------------------------------------= 'g (Plot plan, showing size of lot, location of system in relation to wells buildin s, etc., can be laced on reverse side). -d , FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- - '--� -------------- -•--•-•----------- ,..+5.-,rR•. ,., r 'w, i - DATE----- REVIEWED BY ----------------------------------- DATE ;; ' ;; "i BUILDINGPERMIT ISSUED---------------------------------- ------- ----------------------------------------------------------- DATE------------------------- , ,:' L r Alterations nd or om atio - -i -- - ---- ---- --------------- ------...---- ------------------------- ------------- --- -- --�r -- --- --------- --- -- -- .------------------------------� ": � ;� --- - ----- - - <, - _ _ ---------------- D = ---• -- - -- -- +^fM 1 . .................................... ............................... FINAL INSPECTION BY:----- - ----------- Date............. ... SAN JOAQUIN LOCAL HEALTH DISTRICT 130 Soufh American. Street 300 West Oak Street 132 Sycamore Street' 814 North "C" Sfreet Stockton, California Lodi, California Manteca, California Tracy, California of E5-9---2M iasaas ATWOOO 12-S4 +