3389 - Laserfiche WebLink

Home Browse Search

l APPLICATION FOR SANITATION PERMIT Permit No. 33 1 - I [Complete in Duplicate] `a l� 9 5f-.Z- Date -----. --Date Issued Yon i�'Applicafs hereby made to the San Joaquin Local Health District for a permit to construct and install the work rei descri e This application is made in compliance with Count rdinance No. 49. � . z I JOB ADDRESS D LOCATION __ - - -- _ -- Owner's Name -------------- -------------•------------• ----•- -------=----------------- -------------- -- Pone Address------------------ - ' Contractor's Name_ --- 's -•-- -- ---- • p Phone M Installation will serve: ResidenceA artment House Commercial ❑ Trailer Court ❑ Mgtel ❑ Other ❑ Number of living units: -2Communify umber of bedrooms _ /^� f _. Number o'f baths .-_�___ Lot sizefL-________!_-_9-------- Wafer Supply: Public systems stem y ❑ Private ❑ Depth to Water Table ____.___ ft. Character of soil to a depth of 3 feet: I Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 9__'�Hardpan ❑ Previous Application Made: Yes ❑ i N o ❑ New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic`fank or cesspool permifted if public sQwe� is available within 200 feet.) , � Se tic Jank: i � �,.... _ �u►"'°� - p� Distance from nearest well-__ Dist le fro founFun__-_./_.0____-.Maters l�__._ __ _ 7 ___-Ca acit No, of compartments_-___,_:_ Size .+_�____ ____Liquid de depth--.-. �r ------ ------------ -- p y- I e_�1 Dispos Field: D•rstance from nearest w !!_ _ r r !! ;stance from found tion______ #,_Distance to nearest lot line__ _ Number oz lines------ - -- -----!__:----.-,- _Length of each line_- ��•- - ----- -.__..Width of trench--.---------��` - �------ - Type of filter materiafl _- _ _� _ __ epth of filter material------- --------Total length-411 Seepa e Pit:j 4i Distance to nearest well_.- Distance m foundafion_�.,�.Distan�e to nearest lot line_._ �+ r---------- Number of pits--------- -----------Li d g material------- Size: Diameter-- � ��---------Depth--------- _,?_� Cesspool: Distance from nearest --------------well_________________Distance from foundation-------------------.Lining material--------------------------------------❑ Size. * Diameter--- ------ Dept h ----------------------Liquid Capacity----------------- ---gals. Privy: Distance from nearest well______________ Distance from nenresf building ❑ Distance to nearest lot-line_____ ._- _ _ ___ _..- eling and/or re airin (des rFbe):__ . . �" ► ° N 1 .----•------ ----------------------- ________________________________________________________________f_________-_ I hereby certify that I have prepared fhis application and that the work will be done in accordance with San Joaquin County ordinances, fate laws; and rule and regulations of the San Joaquin Local Health District. s (Signed)------- t Le!!!!--- By:-- --------------(Ow-------••-•-----•---•-- n-- -- -J----�.-�----- --------------------------------------------------- (Plot ner and/or Contractors Plat Ian, win size of lot, location--- ----------------------------------(Title)_____.------------ -_- -- -- - - - - - - ------------------------------ ( P g yof system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- + ------------ --------=----- -------------------------------------------•----------- DATE REVIEWEDBY_ ----------------------------------------------------=--------------------------- DATE--- BUILDING PERMIT ISSUED DATE ------ --------:--------------------------- A aerations and/or.recommendations--- ____.______________ e --- - ---------------------------- _ ' ------------------------ --------------------- - -- - �_l -- -------------- -------• 1 •----------------------------------------------- --------------------------------------------------- ----- ---------- ------------------ �'"" - J FINAL INSPECTION BY:-------- ------�---------- r�;;��------------ Date------- �•-��d'_� �:.�'�- ---�- --- -------�-------------- I SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street 1 Stockton, California Lodi, California Manteca California -� � Tracy, California ES-9-2M 10-52 Revised W-2180