7244 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. _.-) (Complete in Duplicate) Date Issued 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 No. 54 . et 3-- 2-'d— 7_L JOB ADDRESS AN LOCATION_. ____-Y __ _/Q --___--_ --- Owner's Name--- 7 _lQ_(._.- --------H-Q_�C.-_D__p ------ Phone-/f.... Address---- �f V-a--x---- 1 a ------------------------------------------------- •-------------- Contractor's Name.- ------- .... _ - _LS f`I — -/,1-c----------------------------- -------------------------------------------- Phone/.8......6.�-(�Ct7 Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms _. Numberof baths __j---- Lot size ____7_ _____X___l_.?__ ____--------------_____ Water Supply: Public system ❑ Community system ❑ Private CO--Bepth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Ug—Hardpan ❑ Previous Application Made: Yes ❑ No Eja�New Construction: Yes ❑ No U TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: i tante from nearest well------------.---Distance from foundation___________________Material-------------------------------------- --------__. ❑ 15 of compartments--------------------------Size---------------------------•---Liquid depth------------------------- Capacity----------------------- Disposal Field: Distance from nearest well_._'7_1 ._'._Distance from foundation_____ _ _.__ Distance to nearest lot line_Z-O."_____ Number of lines------- --------/ -..-,--Length th of each line------- 4;r_- j r� 9 « -- Width of trench y Type of filter material._.. 5.IK!Depth of filter material____.tj------------Total length-----�}-4_�________________________ / / Seepage Pit: Distance to nearest well_._�..Q__b.__.___Distance fr m foundation____�Q__-_-.Dista fro to nearest lot line_/O__�___ Number of its.-_.-----/_.._. Lininmateriai___�.t_41�Size: Qiameter.___�.�. _.____De th_._._.. _ � Cesspool: Distance from nearest well-----------------Distance from foundation-------.------------Lining material__.-----___.--___._.____._______-____. ❑ Size: Diameter --- Depth------•-------:--------------- ------ --Liquid Capacity---------------------•------gals. Privy: Distance from nearest well..........................._____._.._..____.._._Distance from nearest building--------------------._________.._____._._. ❑ Distance to nearest lot line - -------------------- - -------------------------------------------------------------------------- Remodeling and/or repairing (describe):-------------------------------------- ---------------•-------------------------------------•--• -----------------------•--------------------------"-== --------------------------------•---••------------•------------------------------------------------------------------------------------------------------•------------------------•-••-----....._..--•------------------------ ------------------------------------------ --------•-------------------------•-------------•--------•------------------------------------------------------•--------------------•-------------------------------------- I hereby cer ' that 1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St a ws, and rules and regulatio of the San Joaquin Local Health District. (Signed)•---- -------------- - -- ---------------- --- --------------------- r and/or Contractorl C_ .__ BY=------- --� ------{Title)-------gX --------- ------ (Plot plan, showing size of lot, o anon of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------------------- DATE-----`-��-•--•-------------- REVIEWED BY--------------------------------------------- --- ------ ---_------ ----------- •-- --•-•----------- DATE----- � BUILDING PERMIT ISSUED-----•---------- --------- -- ---------�'rf --------- DATE-- .... �� ------------------------------ Alterations --------------------- --- Alterations and/or recommendations:------------------- ------ -------- ---------------------------------•----------•-----------------•--------•--- -----:......_ ---------- --------------------------•--------------------•----•----------------------------- --------------------••••-------•-----------------------------•----------------•-----------------•------------------------------- ------------------------------------------------------------ ---------------- -----------------------------------------------------------------------------------------------------------------------------------------•------ ----------------------------------------------------------------------•------------------- ---------------------------------------------------------------------------------------------------- ------------------------------ ff FINAL INSPECTION BY:---- - -------------------- Date--------�;�E_?ll-� ------------------------ 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 1 E5-9-2M 145446 ATWOOO 12-54