6416 - Laserfiche WebLink

Home Browse Search

Permit No. ----------- APPLI ATION FOR SANITATION PERMIT (Complete in Duplicate) (P Date Issued Applica}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 ma in compliance,with Co ntxOrd'snance .No. 549, l --------- JOB ADDRESS AND L j� �^ j Owner's Name____ _______ }� ____�_L_t_,__k'�.-' - /ajr,+� _ ------------------ Phonel_1__0_�#-'^��_�_ �� iv Adaress �.. � ..I__+_L. _ .- ---------------------------------- Contractor's Name__. "±A Phone Installation will serve: Residence j ®Apartment House ❑ Commercial ❑ Trai{er Court ❑ Motel ❑ Other [] Number of living units: __L____ Number of bedroomsc�_._ Number baths/_f/ Lot size __�_� _-.__ _ _®__ __________________ Water Supply: Public-:system ❑ Community system ❑ Private Number to Water Table ______ ft. Clay Character of soil to a depth of 3 fee+: Sand El Gravel F1Sandy Loam Q ClY Loam El Clay E] Adobe [Hardpan [j Previous Application Made: Yes ❑ No ® New Construction: Yes © No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permifted•if p blit Sewer is available within 200 feet.) ff J`Jh- __-_____. Septic �nk: Distance from nearest well-._ _�_ ___Distance frq�,}ffoun . ion___ .- __ ,Mat rial_______________________-._,______,..-__ No, of compartments---------.I ----- ----Sizetx--l--a�t_ __Liquid depth--- --------------Capacity--�-- ----� 1 Disposal Field: Distance from nearest well Distance from foundation/ �__ ___-Distance to nearest lot li _____±p - rNumberof lines___._________ ____________Length of each line§5�a_ h Width of trench � Type of filter material __*_7�`Depth of filter material-.-..__ _ _-___-Total length___.____. ►_! _ __ ______________ Seepage Pit: Distance to nearest well-------------------- _Distance from foundation--------------------Distance to nearest lot line---___-___:___-__ t ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth------------------------------._- Cesspool: Distance from nearest well-----------------Distance from foundation-------------------_Lining material-------------------------------------- t El ` Size: Diameter`------------------------- ----Depth----------------------------------------- ----------Liquid Capacity--------------------------gals. IDistance from nearest building Privy: Distance from nearest well--- ----------------------------------------- 9----------------------------------------- ❑� Distance to nearest lot line--------r- --------------- - -------------------------•-•-------•---------------------------------------------------------------------------- Remodeling and/or repairing (describe):--------- ----- -----•----_____-------------------•-----------------•-------------------------,----------------------------- ------------------ ----------•-------------------------------------••--------••------------------------------ r --------------------------------------------------------------•------------ -- -••-------•--_-------•--------------------------------------------------------------- ----------- -------------- s --------------------------- ---- ------------ ----- ` I hereby certif that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sta a s, and rules and regulations of the San Joaquin Local Health District. r {- ------------------------------------------- ---- -----(Owner and/or Contractor) (Signed) ---- - ---------- Title------ ------ By:--------------- --------------------------------- ------ -----------.-------------------------------------------- - (T if plan, showing size of lot, lo`ca+ion of system in relation to wells, buildings, etc., can be placed on reverse side). i °FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY?-- - -------------- ---------------- ------------------------------------------------ --x DATE ----------------- -------------------------------- REVIEWED BY-------------------------- ---- - ---------- ---- -- �----�-------------------------------- DATE_ ------ --- -------------------------------- ------------------ -------------------- ---- ' r�------------._.---------- •- BUILDING PERMIT ISSUED_------'-- ----------------- - - ------- DATE Alterations and/or recommendations---------------------- ------------------------- ------------------------------------------------------ -------—------------------- ------------------ l ---------------- ---------------------------•-------------------------------•-----------•------- --•----•---- -----------•-----------•- ------•---- ---- ------------------- ----- -----—----------------------------___-_-_----__-__-___----___-_-______________-____---__-_.--_-_----_-_-_______ -. • yy �l FINALINSPECTION BY: ............... Date-------------------------------------- ----------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street k, 132 Sycamore Street 814 North "C" Street Stockton, California Lodi; California Manteca, California Tracy, California jffJf/ ES--9-2M 1e .ATwau. 12-54 L 1"