6318 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. _�t. 1... .:"' f (Complete in Duplicate) � Date Issued --.h�/J7�7 pplica{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. 22 -703e0_.1 JOB ADDRESS AND LOCATION � ,!�Do-�-t._• LFS -r .. '- .-- - ` Owner's Name.. ►xs.. .- Phone F�G. / Address_--•--------------- - t n Contractor's Name 5..... . ------------- -------------- ---------------------------------------------- Phone. Installation will serve: Residence [ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [) Other ❑ Number of living units__I.. Number of bedrooms __�Number,of baths I----- Lot sizeu. ------------------------ Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table . `�✓ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam p Clay ❑ Adobe 0--Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes 0'-Na ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) f Septic Tank: Distance from nearest well-I Distance from four}dation_. 40-------. Material___!- '.. * No, of°compartments--- -----------------_Size ..76...�sP_._--._.Liquid depth_.o `.J...---.-. Capacity._-.___�� ._. 3 �� --"'--.Distance_ to nearest lot line-...._.�0 Disposal Meld: Distance from nearrest well...____Distance rom foundation._. .. Number of lines---![__.--------- - Length of each hne---- .'. it- Width of }rent �..�. ./p` Type of.filter material-]_ r... .[�-.-.-..Depth of filter material-.-.f -_.._-......Total length:. _._--_...-.- Seepage Pit: Distance to nearest well_1pQ�...-..._.Distant from foundation-. �----------Distance to nearest lot line_________________ T Number of pits.---I---------------Lining material- ...----Size: Diameter. ` .......-Deptn-- 1-�1----`---------------- N Cesspool: Distance from nearest well-----------------Distance from foundation....................Lining material------------------------------------- 0-, -_____--- ._---------.❑-, Size: Diameter------ ------------------------------Depth--------------------------------- ------- - --------Liquid Capacity------------ Privy: Distance from nearest well-------------------------------------------------Distance from nearest building___-------------------------------------- ❑ Distance to nearest lot line------------------------------ ---$------------•--------------------------------- Remodeling and/or repairing (describe):------ ---------- ----------------------------= ------ ----------.------.. ...._..-----•-•-----------•---------- - - ------•---•----------------•-•--------•---------------- ---------------------------•------------------------------------•------------------------------------------------------------••--•----------------------------------- ---------------------------------------------------••--•----------------------------------------------•------------------------------------••----•---•------------------------------•---------------------------------------- 1 I hereby a 'fy that I,have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, S ate aws, an rules and regulations of the an J aquin oval Health District. (Signed)......... A-e-I :4�f7- -- ---------- ------ i------ -------- . `------------------------------------ - ------ - ontractor) By:--------- ----------------------------------------------•---- ---- - `, - - -- --------------•--•---------(Title) ' (Plot plan, showing size of lot, location of system in dation to wells, bu' mgs, etc., can be aced on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.------ -----•--•----------------------------- DATE--------------= - REVIEWED BY----------------------------------- ------- DATE ------ BUILDING PERMIT ISSUED------------------------------- ------------------------------------------------------ --- DATE.---- --------------------•----------- -- Alterationsand/or recommendations-------- -------------- ---------------------- - -------------------------------------------------------------------------------••-----------------•----•------- l ------------------ -------------------------------•----------------------------- ----- --------------•----------------------------_--------------------------------------------------------------------------------------- ------------------- --------•-------------------•--------------------------- -------------- ----•------------------------------ ---------------------------•-------•--- --------------- -- ------- ----------------- ------------.. F1NAL INSPECTION BY: _ --------------------Date---- `....---- -------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Streot 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES- -.- 145446 AT-.-. 12.54 , Y'F