6654 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. lComplete in Duplicate) Date- Issued Applic64-;on 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................ -----st Owner's Name------------------ --------------- -------- L&----------------------------- ---------- Phone---------------- Address-------------------- --------------------------------- - , Contractor's Name ------ Vt .... - ------------------ ------- Phone Installation will serve: Residence [jo-Apartment House [] Commercial E] Trailer Court L] Motel r _] Other ❑ Number of living units-. _/.----- Number of bedrooms .-3- Number of baths --- ... Lot size ----- 7 ?------------- Water Supply: Public system P-<Ommun-ify system [3 'Private El Depth to Wafer Table -------- ft. Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam 9-150ay Loam E] Clay Ej Adobe 0 Hardpan E] Previous Application Made: Yes [T< El New Construction: Yeskff-717E—] 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-.Dista ace fromnclation----/-A-77"Materl k No. of compartments--------- ----------Size-,?X-qx ------m---Liquid deth----------- th ----------Capacity-- _-- Disposal Field: Distance from near ------ --------Length of each lineC well-))-^-V-Distance from foundation---- Distance to nearest lot line- Number of lines-- A - - 4 IWidth of trench-------_-71. T- Type of filter material-!5'r.-Q<.I._Depth of filter material . ..........Total length-------- ,_Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------------Distance to nearest iot linb------------ El Number of pits----------------------Lining material--_--_-.-.---- ---.Size: Diameter------------- 14 -- ----Dept h----------- Cesspool: Distance from-nearest well-----------------Distance from foundation____________________Lining--------------Lining material A --- -------------- ------ 0 Size: Diameter-----------=-------------------------Dept h--------------------------------------------------.-Liquid Capacity-------------'�:�--_- gals. S� Privy: Distance from nearest well------------------------ --------------------Distance from nearest building-----..--__-------_---------------------- Distance'to nearest lot line------ ---------------------------- Remodeling and/or repairing (descr;be)!------------------- .- -------- f ------------------------------ ----------------------------------------------- -----------------------------------------------------------------------------*----------------------------------------------------------------*---------------*----------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -----------------------------------------------:----------------------------------------------------------- -------------------------------------- --------- ----------------------------------------------------------- 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)----------•--------------------------------A.. 2rr---------!?-•- -- ----------------------------------------------------------------------- -- --------(?�wner��/or Co;i'ractor) By:- -------------------------- -----------------------------------------(Title)---- ------------------------ (plot plan, ing.size of lot, locrfioWof system in relation to wells, buildings,..efe., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------------------- ---- --- ---40�--------------------------------------------- DATE------------- 4 ------------------------ REVIEWED BY------------------------------ ----------------------------------- ----------- ------------------------- ---------------------- DATE BUILDINGPERMIT ISSUED-------------- ------------------ ---------------------------------------- ---------------------.... DATE----------- ----------- ----------------------- Alterations and/or recommendations:--------------------- ---- --- -- 7-------------------------- ------------------------------------------------------ ----------------------- ------------------------------------------------------- ---------------------------- ------------------------------------------------------- -------------------------------------------------------------- ------------------------------------------------------ ------------------------- -------------------------------------- -------------------- I ------------------------------------------------------------------ -------------------------------------- -------------------------------------------------------------------------------------------------- -------------------------------- ------------------------------------------------------------------------------------------ ------ --------------------------- ---------------------------------I---------------------- FINAL INSPECTION BY:------T""- -.------------------- - ------------ Date..... ----- O -- f 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 745446 ATWZIQO 12-54