6484 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. ..... _ LA 11 (Complete in Duplicate) 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. JOB ADDRESS LOC 101 ' ,r,. , ,� r N!'- r ---------------------------------- _ / t ----`-''� .. Owner's Name �'t== == `F� - � y Phone Address , ..;,_- - -------------- -------------------- ! ---- Contractor's Name---- --------------•----------------------------------- ----._. Phone----------------------------------- Installation will serve: Residence Q/Apartment House ❑ Commercial ❑ Trailer Court ❑ M'ptel ❑ Other ❑ Number of living units: __A_.. Number of bedrooms _.E= . Number f baths ---/---- Lot size ___'..�_____4------------------------------------------- i _ __:`=-_ ___________________________ Water Supply: Public system ❑ Community system ❑ Private ✓[Depth Water Table _..._.._ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ f Previous Application Made: Yes ❑ No � 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 -- __ t` Distance from foundation �0_ �i _ .Mater alr ,, ---- - ❑ No. of compartments_____ _ .. -__Size,1 f ` _ �-------Liquid ;Depth_-.-, -.P_ ._Capacity... Dispos.�j Field: Distance from nearest welkt -/ tr R ~Distance from foundation.'4---- ...Distance to nearest lot linb,.k i `e E�fNumber of lines_ _ ' �' ._Length of each line____� .:rt_ _-Width of trench .> t _ Type or filter material'`; 1 __ Depth of filter material. ..__.f-----------Total length____---. . _ _______________.. Seepage Pit: Distance to nearest well_--------------------Distance from foundation-_---__-_-_-_--.-.Distance to nearest lot line_-__.-__-__--_ ❑ Number of pits_________________Lining material___________________-Size: Diameter-----------------------Depth______----___---------_------_ 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--------- -----------------------------------------------------------------------------------------------------------•-------------------- Remodeling and/or repairing (describe):------------%-------------------- ------------------------------------------ ------ ----------------------------- ------ ---- -•------------------------ - -------------- ------------- -- - --- - ----. = ----- -- ------- ----- ----------------------------------------------- --- ----------------------------------------------------I------------------ ------------------------------------------------------------------------------------------------------------------------------- -- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Ste Daws,,and rules and regulations of the San Joaquin Local Health District. (Signed) `= _ - --------------- —----------------- ---- ----------------------------- -------- ---------(Owner and/or Contractor) By:------------------------------------------------------------------------------------------------------ -----------------------------(Title)---------------------------------------------------------------- (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 BYE - DATE =-------------------------------------------- REVIEWEDBY------------------ ------------ *------------------------------------------------------------------------------- DATE r�- _-------------------------------------------------- BUILDING PERMIT ISSUED---------- DATE--------- "--- ---------------- Alterations and/or recommendations:-- - -----------------------•--------------- -•---------------------------------•---------------.-•------ ------ --------------------------------------------------------------•-------- ---------- --------- --------- -----------------------------------------I-----------I---------------------------------------------------------- ---------- -- --------------------------------------- ----- ------------------- ---•----- ------ ------------------------------------------------------------------------•---------------------------------- --------------------- -------------- ----------------------------------------------------------------------------- --------------------------------------------------•-------------- ------------------- ---------. - ----------------- ---------------------- ----------- --- -------------------------------• --------------- ......._------- -------------•--------- ------------------------------------- �/n � " FINAL INSPECTION BY:_......j�--' `'�.� =;'� ' Date--- ` _' 15 SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 614 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 145446 ATwOOD 12-54