4077 (2) - Laserfiche WebLink

Home Browse Search

V, - - 1, / - APPLICATION FOR SANITATION RERMIT Permit No, (Complete in Duplicate) CDate Issued IVAP 6-� S ___.�.Z�••`.3 Application is here y 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. JOB ADDRESS AND LOCATION._P.c�/.,Z/-4F---L------ - ` Owner's Name--------- ----------- -------- 7----- ------------------------------------------ - ----- ---------------------- ------------- Phone_--_Address_-------- . ...... Contractor's Name. -----•---------------•---------•-------------------•-------- --------I------- -------•-- ----- --------- Phone---- --`- - Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _/---- Number of bedrooms _!Number of baths __/-_-- Lot size - .f'_-�-_ 1 �� — 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 ❑ Cla Previous Application Made: Yes:❑I No K New Construction: Yes [I No ❑,� L yp❑�Adabe Hardpan E]TYPE OF INSTALLATION AND SPECIFICATIONS: ✓ r (No septic tank or cesspool permitted if public sewer is available within 200 feet.) �Tan Distance from nearest well_________________Distance from foundation o Fi id: foundation__________No. of compartments_.._._.-- -------Material------------------------------------------------ ---- Srze_.__---------------------------Liquid depth--------------------------Capacity---------- -------- Distance from nearest well. . 0l�1k.Distance from foundation___I� .__.Distance to nearest lot lie a� W Number F. or Irnes_._-----)-----_.. ry Length of each line______ __ - ---------Width of trench �r a Type of fi)ter material____ /,' j, k_Depth of filter material____-__1_$_--_____Total length-_______ Q Seepage Pit: Distance to nearest well-----_----------------Distance from foundation__ ------------------- Distance to nearest lot line__.__._.__.______ ❑ Number of pits-- ----------------Lining material---------------------..Size: Diameter-----------------------Depth----------- ---- - Cesspool: Distance from nearest well_________________Distance from foundation ____-_____.__----.Lining material---------- El Sizu: Diameter.----- --------------------- -- ---- ---- ----- --- ------- Depth--------------------------------- Liquid Capacity Distance from nearest well--------------- =-•-- --------------------gals. -_-__-__._Distance from nearest building_______________________ ❑ Distance to nearest lot line._.__--------------------- , Remodeling and/or repairing fclescril e)`� _�_�_ --- ---- l ____ _i --- - - ---- •------------ ••---------•---•---------•--------------------- ------ ... -•-- -- ------ -•---- ----- ----- ------- - - --- - - -- ----------- - ---- ---- ------ - - ----- I hereby certify that I have prepared this application and that the work will be lane in accordance with San Joaquin County ordinances, d#�{e laws, and rules and gulations of the San Joaquin Local Health District. (Signed)•----A----- ---- --- --- - By-------------------------------------- 1 (Title)_. Contractor) (Plot plan, showing size of lot, location+of system in relati n to wells, buil ins a+c., can be pi cad on reverse side) 9 � -------------------- FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_ -- I- DATE_- ------------------------------------------ REVIEWED BY-----�----------------•--- -- BUILDING PERMIT ISSUED---•-------_- DATE------T --------------------- ------------ ................... ..... ----- ----------- ------------------------------ --------- ----------- ---------- DATE-------�-b_ Alterations and/or recommendations__ ....._____-_._._ ----------- --------- ----"---- �-------- ------------------------------ ------------------- ----------•--------- - - ------------------------------------------ ------------------ -----•---------------- - -- ------------------------ - ---------------------------- -------------------------- - ------------------------------------------ ---- FINAL INSPECTION BY________________ f/----- Date-.. ---- ----------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore S}ree+' Stockton, California � 814 North "C" $}reef Lodi, California Manteca, California Tracy, California E5--9-2M 10-52 Revised W-2100