2784 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No.�. .............. I (Complete in Duplicate) 7/ v V date Issued _______ Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. j This application is made in compliance with County Ordinance No. 549 '04. - �JOS ADDRESS AND LOCATION-------- -F-� ,_-�J -- -- ----- ---- -v-�-- ------- - --�'•--- -�n-------------------------------------- ( Owner's Name------------------------------------ L�Q1 _1C/_�lD --------------------------- ----------- + Phone Q.L -� I Address---------------------------------------------- -- �_YY1 ------------------ -----------------------------------------------------------------.-.------------ Contractors Name--------------------- 14 ---. —P _.� +__- �c - Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: I----- Number of bedrooms'2-'- Number of baths __t-_- Lot size ----------------------- Water Supply: Public system 0 Community system ❑ Private ❑ Depth to Water Table/*/vft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ' Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: V� (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_JY0-?W--Distance from foundation---l49- -_-------Material-_!✓ _5A No. of compartment-s-------------�L--------Sizer--37-__�4X_-Liquid depth---67-2--_-..........Capacity----------------------- Disposal Field: Distance from nearest well-------------------Distance from foundation--------------------Distance to nearest lot line-___----.-------. E] Number of lines------------------------------------Length of each line------------------------------Width of trench----------------------------------- Type of filter material-----_--_rr-----------------Depth of filter material----------------------- length_--___-___-__---------------------___-.- Seepa e Pit: Distance to nearest well--1-],-a-��.---Distant�rf�,m_ f ndation-, '--�'o_---_.Distance to nearest lot lino?f---_ 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 -- ------------------------------------------------------------------------------------------------------------------------------ Remodeling and/or repairing (describe):------ ------------------------------------------------------------------------------------------------------------- •----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------•---------------------••----------------------•------------------------------------ ------------•-------------------------------------------------------------------------------------------------- -------------------------------------------------------------•.--------------------------------------------------------------------------------------- ------------------------------------------------------------------- I hereby certify that have prepared this a lication and that the work will be done in accordance with San Joaquin County ordinances, State I s, nd rules and regul +ons the San Joaquin Local Health District. (Signed)----- { ; RR � � ons------- `� � � f~ (� Contractor) s -- B --------- ---------- -ftp- {Title) �` �. �} L� .-------------- (Plot plan, wing size of, Iota ion of system In relation to wells, buildings, etc., can be placed on reverse side). r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - DATE ------------------------------- ------------------- REVIEWEDBY----------------------------- --- - -------------- - -------- ------- ---------------------------- DATE------ ----------------------------------------------- BUILDING - _ BUILDINGPERMIT ISSUED-------------------------------------------------------------- --------------------------------------- DATE---------- ----------------------------------------------- Alterations ---- ----------- - ------- ----------Alterations and/or recommendations:------------------------- -----------------------------------------------------------------------------------------------------•------...._------ ------- " -------------------------------•------------------------------------------------------------------------------------- --------------------------------------•-----------•----------------------------------------------- I -------•---------------•----------------------------------------------------------------------------------------------------------------------------------------------`---------------------------------••------------------- ------------------------------------------------------------------------------------------------------ ------- - -------------------------•--------------------------------------------------------------------------- -------------------------------------------------------------------------------•------0------------•--------------------------- � f FINAL INSPECTION BY:--------`��:e� ---------------- Date-------� j /"` 1�-•-------------•------- 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 8-51 Revised W-2100