6439 - Laserfiche WebLink

Home Browse Search

�` • APPLICATION FOR SANITATION PERMIT Permit No. .- r • (Complete in Duplicate) Date Issued .G/7�ZA_57' Applica+ion is hereby made to the'San Joaquin Local Health District for a permit to construct and install the work herein described. This application ;s made in compliance with County Ordinance No. 549. _t ? JOB ADDRESS AND LOCATION----- I--�----6-0------ a ------�WI_ ---. ---------------• ---= Owner's Na e Ul -----101------- • / Phone------------------------------------ Add -:------ - - . -- ----•------ ---- ----- - -- -- ------- ---- ------------- .............. c4ontractor's Name , �-4 ---- - ---- F f�..t - { Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ • Number of living units: ---�._- Number of bedrooms ---rv.._ Number of baths _ -- Lot size ------5- ------- -- -- -- __-_______ E� Water Supply: Public system [_ Community system ❑ Private ❑ Depth to Water Table ,_'�_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel El Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No 2;_ New Construction: Yes ❑ No,, TYPE OF INSTALLATION AND SPECIFICATIONS- (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 6 Septic Tank: Distance from nearest well---14/&Distance from foundatio o - Materia)_---C-0.0—-40____ __ __ _____--__. No. of compartments-.---.!�-------------Size %--- _,?�._X kiquid depth.----'_----.---------Capacity----- - -------------- Disposal Field: Distance from nearest well.../*—aeDistance from foundation_ ..._-_.Distance to nearest lot hne.----;{O...... Number of lines______._ __. • g �1 ...... --._.Width of trench.--- -_ .. ____Len Length of each line________- -. Type or fitter material-- .._._✓</2,__Depth of filter material___._./��__--.__.Total length_--______-�_�_Q--------------------- 1 Seepage Pit: Distance to nearest well__/VQ-jV�Distance from foundation__JQ___....Distan�e to ne rest lot line___-_��_�_ Number of pits -- --- 9 1 .��..-----...Depth..----.. �1� ___Linin material__F-� ._._._.__. ta: Diameter._.__ Cesspool: Distance from nearest well________________Distance from foundation------------ Lining material----------_-`-------_------_--_----_ Size: Diameter ------------- -----Depth. __. .- _.. .---ice --L-quid"Capazity_.. ",7 _ _ - _ Privy: Distance from nearest well------------------------------------------------Distance from nearest building--------------------------------------_-- r ❑ Distance to nearest lot line--------------------------------------------- ------------------•---------------------------------------------------------------------------- �� Remodelingand/or repairing {describe):-------------------------------------- -----------------------------------------------------------------------------•---------------------------------- r[ • e V -------------------------------- ---------------- --------------------------------------------•---------------------------------------------- •--•------------------------ -------------- ---------•---•-------------------------------------------------------.--------------------------------------------------------------------------------------------------••----------- ---------- __ -----------•--- t I hereby certify that l have prepared this application and that the work will bei done in accordance with San Joaquin County ordinances, Stat aws, and rules and regulations of the-San Joaquin Local Health District. (Signed)........ -------- -------------- ---- - --'��. -------- ------ ---------------------- -----------------------------------------(Owner and/or Contractor) �f By:- a�� 1. .� • -------•- --------------(Title)---- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., Canr be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY - ---------- -- ------- ---------------------------------------------------------- DATE6' —_3 _-------•------------------------------------------- REVIEWED BY------------- ------------ DATEf BUILDINGPERMIT ISSUED------------------ ---------------------------------------------------------------------------------- DATE- Alta - .. ations and/or recomme ations• - ------- _ -� -- - _...e-; -- 4 ,_ . . r�- _: ?v A,jut-.- �A� ----------------- ----- ----------------------------------- ----------------------------------I---------------------------------- --------------- -----------------------------------------------------------------•---------------------------------------------------------- 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 145446 ATWCDO 12-sn