5392 - Laserfiche WebLink

Home Browse Search

�► Permit No. __ .___J ------ APPLICATION FOR SANITATION PERMIT # 1 (Complete in Duplicate). Date Issued 7 Applica-ion is hereby made to the San Joaquin Local Health District for a permit to construct and-install the work herein described. 4 This application is made in compliance with County Ordinance No. 549. O2�. JOB-ADDRESS AND LOCATIO ----- ------- - ------------- Owner's Name------ ,.M^ -A__ - ------------------ ---- - - - -------------------------------------- Phone_.--1-1g-_. 4------ • --------------;-X-------------------- Contractor's Name tom' Phone• r Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ ; f-- Number of living units ____ Number of bedrooms.---: Number of baths _,/___ Lot size -------------------------------- ' Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table K/ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeM Hardpan ❑ .,.£ Previous Application Made: Yes ❑ Nox New Construction: Yesx-, ❑ ' 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--_�Q_'__Distance from foundation---/C1__ ___.Material-- / _ ___ _ __ _____________________-- No. of compartments------0._ --------------_Size_la � �--- Liquid depth_-_ __-_ 3_____-Capacity_.._ _'i'___ Disposal Field: Distance from nearest welL_�C1___�--_Distance.from foundati n_ _ __�--.-__.Distance to nearest lot line_____ Number of lines--------1---------------- ------Length'of each-lin ��-�----.Width of trench-- _ _-� ------------------------ Type of filter material -_----___De th of filter mat i -'..--'--_Total length_ _ __ __________� - ------- '7 - ; Seepage Pit: Distance to nearest well_-__- �_--___Distance from undation____ _...___Distance to e est lot line__.__ X, Number of pits-----/--------------Lining material 1 . -_ _--.Size: Diameter--- Cl'�_.__- - - ------------ . Cesspool: Distance from nearest well_________________Distance from foundation____- --__.______.Lining material-------------------------------------- It ❑ Size: Diameter------------------ -------------------Depth-------------`-:- 7 --------- - Liquid Capacity gals. Privy: Distance from nearest•well---------------------------------------------!-=-Distance-from nearest-building-----_-----------------------------------. ❑ Distance to nearest lot line-- ------------------ --------------------- ---•-- ----------------------------------•-------------------------------- -------------------._ Remodeling and/or repairing (describe}:_+_,/ --------------------------------------------------•---••----------- ----------- ---•------------------------------------ - - - - - - . ...-= i . - ------ -------------- �. I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County i ordinances, State s, and ru, s and regulations of the San Joaquin Local Health District. <� ` -------------------------(Ow er and/or Contractor)a [Signed} �� -- ---- ------------ sY M-7 --- - ---- ------------------------------------ = (Titl - :_e(Plot plan, showing sizea ion of system in relation to wells, buildings, etc., can be ced on reverse sr e). " FOR DEPARTMENT USE ONLY r. APPLICATION ACCEPTED BY------- ----------------- ----------- ----------------------------------------------- DATE------- REVIEWEDBY------------------------------ ----------------------------- --- = DATE BUILDING PERMIT ISSUED----------------------------- ----------------------------------------- =dDATE----------`-`------------------------------------------------- ---------------------------- �------------------------------•---- --------------------------------•------------ Aiterations and/or recommendations:---------------------------------�------ ---r*-------------------- i ----•---------------------•----------- `- ..-- -- -- --- - ------ r 7 ---- -- ------ A --------------------------------------------- ---------------------------------------------------------------------------------------- F1NAL INSPECTION BY:....-------�------- :�-----'�J------------------ Date----- ---=---- ------------- - ------------------- f SAN JOAQUIN LOCAL HEALTH DISTRICT Y 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 Revised W-2100 ; Ar