6196 - Laserfiche WebLink

Home Browse Search

ve APPLICATION FOR SANITATION PERMIT Permit No. __ 1 ..____ " (Complete in Duplicate) W911/ss 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. 549. F 1 JOB ADDRESS AND LOCATI N.. ------- �� `��' :5 - '--------'------------------------------------------r-- _------------ Owner's Name 1� ---I- �� Phone t Address---------------- r . , Contractor's Name.- i = e5p -.X------A-------- ------------------------------------------------------------ •------ Phone....-------------------- - ---------------- ---------- Installation will serve: tResidence ❑ Apartment House'❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: ________ Num f bedrooms ________ Number of baths _-____ Lotsize .--,____----- "•- -_1 _____r___._ r Water Supply: 'Publ0system ommunity system ❑ Private ❑ Depth to Water Table.-'_.___ Character of soil to a depth of 3 feet: Sand ravel ❑ Sandy Loam ❑ ay Loam} Clay ❑,, Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: c (No septic tank or cesspo6l permitted if public sewer is available within 200 feet.) _! Septic Tank: Distance from nearest tance fro' njnda+ion__ '�I_ Material_ .- --._'_ ______T K No`. of compartments______.__ _ _ Liquid depth_-_-___ _ p --5ize___1j1'� Ca acct Disposal Field: Distance from nearest well-/��'�istance from foundation/___ ____. . .Distance to nearest lot line____ -- -- - - ------ Number of lines______________ r-^ __ ___Length of.each line__ Width of trench-__-__ -__4 .1--------- ---- _--- - -= Type of filter material-_ _t _,fDepth of filter matenal_.1�______._____Total length_______ _ �_-' ---------- Seepage ____._ See a e Pit-."" Distance to nearest well____--.-__ __—-__-__Distance from foundation...............:....Distance to nearest lot lS"ne---._____________ ❑ Number of pits---------=------------Lining material-----------------------Size: Diameter-----------------------Deptn-------.-------------- --------- p, Cesspool:, Distance from nearest well_________________Distance from foundation------------ --- Lining material____.._____________.____________---_. ❑ Size: Diameter------------- ------Depth_------_- ---------------:---------------------------Liquid Capacity-.--------------------------gals. (� Privy Dis#ance from nearest welL___________.__� _____________________________Distance from nearest building___._..._______________________,-------- - . ❑ - - Distance to nearest lot-line------------------------ -- --------------------------- Remodeling and/or repairing (describe)______________________ .- I # ---------------•....-_-------•-----------------------------------i--------------------------------=----=-•---- ------------------•--•-------------------- -----------•------- -------------------------------------- -------------------•----------•--------------------------------------------•--•----------•------------------------------------------------.•-------.•----=---------.--•------------------------------------------------------ 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)------ C -!,✓=' - � = — - - ------ -----------------------------------=----------------------(Owner and/or Contractor) ► j-------•--------..I----------•-------------------------------------------------------------•-------•------- Title -----•------------------------------------ By:._..-------•-------=--- { )---------------------- (Plot plan, showing size of lot, Iocation of system in relation to wells, buildings, etc., can be placed on reverse side). r . FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------------- ------------ ---------------------------------------- DATE------- -- - REVIEWED BY------------'•---------------------------- -• I-----'= -------------------------- DATE--------------------:...------------ - ------------------------------- .--.- ---------...---•------- BUILDINGPERMIT ISSUED------------=-------------•------------------------------------ ------ DATE--------------------------------------------------------- Alterations and/or.recommendations: -=---- ------------------- ------ - ---- - --------------- jj ::_i-- ---- -------- -------------------------------------- ----------- 9,I--- �. -------------------------------------- Af-------.---- =.�: -------6-19 ----------- � - 1 FINAL INSPECTION ---=-- 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 ES-9-2M ' Revised W-2100 f