4221 - Laserfiche WebLink

Home Browse Search

f APPLICATION FOR SANITATION PERMIT Permit No. Y... �. (Complete in Duplicate) j S Date Issued Application 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........2-5-1- -'_ Owner's Name----------------------------------------- /`1--------- --------------------- Phone-__�4.b -- AddressiC77A -- ........ Contractor's Name----------- ..................... i 5 ------------ Phone.....!-� Installation will serve: Residence Cg Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___ Number of bedrooms . Number of baths .,___ Lot size ----- 4---- x_.____��_�.. Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe& Hardpan ❑ Previous Application Made: Yes ❑ No A- New Construction: Yes ❑ No ❑ G"&A*lln ►�i�, F", ce' Zf _A,,,.,, TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) is Tan : Distance from nearest well______________Distance from foundation--------------------Material_________________-_-_________----.__.__-__.___. `"` a No. of compartments------------ ------------Size-----_-----------------------Liquid depth--------------------------Capacity------------------ g isaLY l ',y Distance from nearest well_-0-11___Distance from foundation__ )--- ..._..Distance -to nearest lot line._Q.......—rwV Number of lines______ Length of each of trent -�.2�'!�e'ca,t v' Type or filter material___ ___1 yp ; �,_---Depth of filter material-----s-�-.l`�'*---Total length......7 ------------------� Seepage Pit: Distance to nearest well_ Q_�-------Distance fr m foundation_1'�7__.......Distance to nearest lot line_`�-'' Number of pits ---------- Lining materials�-----Size: Diameter---13 -3...-- ----Depth---.Za-Z------------------ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- 1:1 Size: Diameter--------------------------------------Depth------•---------•-------------------------------._Liquid Capacity-----------•-------••------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-------------------------__-_-_________- ❑ Distance to nearest lot line-------------------------•------•-•--------•-----------------••--•---• Remodelingand/or repairing(describe) ------------------------------------------------------------------------------------------------------------------------------------------ ---------------------------•-----------------------------------------------------•---•-----------------------•-----------------------------------------------------------------•--------------------------------------------- ------------------------------------------------------------------------------------•-•-----------------------------------------------------------------------------------.._..-------------------------------------------- -------------------------------------I---------------- ------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------- I -------------------------------------------- ------I hereby ce ify that I.have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, ate laws, and rul and regulations of the San Joaquin Local Health District. (Signed)....... ----------------Klation ----- ------------------------------------------------------------.� Contractor) By: --- ---- ---rildings, -----------------------(Title)---- 5-L!_/'YI.fJG-f�. ------------- (Plot plan, showing size of lot, location of system ino wells, b etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-----_------------------ ---------------------- DATE... REVIEWED BY --------------------- �jt 1+�---------------.._... DATE _. 'S -------------------- BUILDING .--- -- BUILDINGPERMIT ISSUED---------------------_---------------------------------------------------------------------------- DATE----- ------------------------------------------------------ Alterationsand/or recommendations-------------------------- ------------------- ---------------------------------------------------------------------------•-----------------------........... -------------------------......-----------------------------------------------•-------------------------------------------------------------------........................................................................... -------------------------------------•----------------------------------------------------------- -----------------------------------------------------------------------............................................ FINAL INSPECTION BY:.------. -------------------------------- ------------------ Date-• / --------- --------------------------------------� SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street $14 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 10-52 Revised W-2100