4553 - Laserfiche WebLink

Home Browse Search

el 4- _y I a 'Y6 APPLICATION FOR SANITATION PERMIT Permit No-�--�--_�---� \�' (Complete in Duplicate) `� Date Issued _ al, �-j Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the wort: herein described. This application is made in compliance with County Ordinance No. 549. / JOB ADDRESS AND LOCATION___ ---- _-._._______ _a 2-- ,- Owner's Name------------- / ---------- -------------------------------- ------- 4 -_---_-_--_-_-- � � ---tT � � -------Phone - Address_ - - b- - - -- ----- -------------------- Contractor's ----------Contractor's Name - --------------------------------------•----------- _-----------------•-----------------------------•-------------------- ------------------------------ Phone----------------------- •:--------- Installation will serve: Residence Pr7par4ment House ❑. Commercial ❑ Trailer Court ❑ otel ❑ Other � f ❑ Number of living units: ___.____ Number of bedrooms_- Number of baths __l.___ Lot size ._ ____P__ _. l r" 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 ❑ Clay ❑ Adobe ET Hardpan ❑ Previous Application Made: Yes ❑ No 99---"New Construction: Yes E�.`No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: , ] (No septic tank or cesspool permitted if public sewer is available within 200 feet.) - l—I / Septic Tank: Distance from neares7well__ G--__.Distance from foundation----l_G_-_------Material_____ No. of compartments-------Zn _--------Size _-_ f T Q ' III x+{--X--y-�-��-----Liquid depth__c�- =--- ----- Capacity-,_�_4_d-------.7�j Disposal Field: Distance from nearest well .L�'3_-_._Distance from foun 'on___ _. tance to nearest lot line___ Number of lines----.-_ Length of each line___ _t`; idth of french___�-_4F -� Type of filter material _____ [ (a ri- ept of filter material----- ---- -----------Total length----4-- ------------------------- --- ----------- 1 Seepage Pit: Distance to nearest well...... _ -Distance from foundation______________-___ Distance to nearest lot line_____.____._-_-__ ❑ Number of pits----------------------Lining material------------- -------Size: Diameter----•----------------------------Depth------------- ------------ esspool: Distance from nearest well_________________Distance from foundation--------------------Lining material------------------------------------- ID Size: Diameter-------------------------------------Depth----------------------------------------------- ----Liquid Capacity---------------------------gals.Privy-, Distance from nearest well----- ..__.___________________ Distance from nearest buildin Distance to nearest lot line 9 Remodeling and/or repairing (describe):_____________________ _ ----•------------------ -----------------------------------------------•------------------------------------------------------------------------------------------------------------------------------- ---- ---- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed) = .� ° - ,•" r!�' r,4 -------------------------- ----------- --------------(Owner and/or Contractor) - By--------- ---------------------------------------------------------------- Title _ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------- ---- _- _____ REVIEWED BY------------------------- ......... -- - -------- -11 - ------ BUILDING PERMIT ISSUED________________________ - -- DATE _ - --- -------�---- --------------- Alterations and/or recommendations:- -------- 4 1•4-------.:--- ----- ----:- �Zt : _ -------------------! - � --------- -------------- - -- .-z ---- -- ,P f.✓ /J ----------------- : t34- _. - - -_ ----------- FINAL INSPECTION BY------------ ----� ------ ------------------------- Date---------- SAN JOAQUIN LOCAL HEALTH DISTRICT 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 10-52 Revised W-2100