2661 - Laserfiche WebLink

Home Browse Search

�+ APPLICATION FOR SANITATION PERMIT Permit No. }+' (Complete in Duplicate) Date Issued --�-_�Z 3__---- Application 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 N 549. JOB ADDRESS AND LOCATION .9-79 1 l #--- 1 _J!7 -:/A_/��_72_7/ - /`J/jr_--,, Owner's Name--------- .- 1 --------�e_l------ / -dr'� ----------------- Phone----- Address---------•-------------- &__ ------------------------- ---------- i Contractor's Name------- __a .. -- ---/--•---------�-�-�-•(-.�-#7° ----- ---- ��-------�..�>a"-!��f------ Phone-- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units 6- Number of bedrooms J-__- Number of baths _ _---- Lot size ___ Water Supply: Public system "( Community system ❑ Private ❑ Depth to Water Table.7s"`ft. Character of soil to a depth of 3 feet: Sand [❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No �K New Construction: Yes El No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) a, V Septic Tank: Distance from nearest well- l -Distance from foundation__ fJ--__-__--.Material__-&A(C No. of compartments---- Wa------Size r' _- -, i,Liquid depth--�. _E/---------Capacity__ bjo�__�f Disposal Field: Distance from nearest well_/Y7A4C_.Distance from foundation__'__ __'? p -- /�Q --------Distance to nearest lot linel' e----__---- Number of lines---.Q � -----------------Length of each line__-_�.C?'r 4 Width of trench_,2 !! ------------------- Type of filter materiall'y�t----_ftk,_Depth of filter material_---_1�-------._Total length-. ------------------------ Seepage Pit: Distance to nearest w II- _ - hf —_Distance from foundation_-_-- --- 4- D stage to nearest to line___----_ Number of pits-A- -E-------Lining material__19�f-_C/4.Size: Diameter.-- ,�-_----------Depth--v-44-7--- -------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- 11 Size: _----------_-------___-----_-. - Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity-----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ El Distance _--_-.-- _----._---_---------•------ Distance to nearest lot line--------- • ----------•----------------------- -- -- Remodeling and/or repairing _____________�(,o �------ h -/ ------------ ---- _ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sfateblaws, and rules and reclu'jafions of the San Joaquin Local Health District. S(Signed) 4C� --------2 _ /&_/ ---(Owner,and/or Co tractor) By:---- '------Z� - ----------- --- - --- ---- (Title} (Pl( p 9 .. ot Ian, showing 0.,. f of location of system in relat on to wells, buildings, etc., can be placedon reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------- -. f ----------------------------------------------------------- DATE------ - -------------- _ /..- ( � ' REVIEWED BY v kDATE � /� ✓� v ------------ BUILDING PERMIT ISSUED-------------------------------------- --------------------------------------------------- --------- -DATE= Alterations and/or recommendations---------------------------------- ------------------------------------------------------- -----------------------------------------------------------------------•--------------------------------------- ----------------------------------------------------------------- -------------------------------------------------------------------------------------------------- ----------------------------------------- ----•-•---------------------•------------------- -------------------------------------------- ---------------------------------- ----I-----------------------------------------------------------------------------------------------------•-- FINAL INSPECTION BY:------ 1114-------------------------------- Date----------- /. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 306 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