19498 - Laserfiche WebLink

Home Browse Search

rvR urrii,t Ubt: SINN..-. . _ .- , ------ ----- - -------------------------- ------------__---------------- APPLICATION FOR SANITATION PERMIT —Perms*. No, _••- -------------- (Complete in Duplicate) This Permit Expires 1 Year From Date Issued Date Issued --- -_ A 5th Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the wog herein described / This application is made in compliance with County Ordinance No. 549. p� - R . 1 JOB ADDRESS AND LOCATION ._ Dom --V - - Owner s Name------------- �--Xi-------D-u-m--A-------- t ne n p - - - - �-------- ------�- ------�-=--- ----- - Address r ..- •. =s0- f7-------`----a•�'l�_II - --= Contractor's Name_J"_7'C `--=5_e_PT_t. _1�_I � --- Installation will serve: Residence � Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: e Aq Number of bedrooms .3-Number Number of baths I--- Lot size -------------- Water ` Water Supply: Public system ❑ Community system ❑ Private g2l'bepth to Water Table M,ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loarn ❑ Clay Loam p Clay ❑ Adobe ❑ Hardpan ❑ Previous Application_Made: _(If yes,d ate......._________ ) _No ®�New,Construction: _Yes,❑ -No �EHA/VA:�Yes No TYPE OF INSTALLATION AND SPECIFICATIONS: x (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well !40-.__Distan from foundation----/0--__--- _.Ma No. of compartments_.-.__ --------- x1 X _Liquid depth.... �7—------Capacity__ .-------------- .' Disposal Field: Distance from nearest well__, 0"__Distance from foundation-----1Q ___-Distance to nearest lot line___ ,r Number of lines----_- --- -- -------- -----Length of each line---- f.�'�-- � .Width of trench._--, --- -- Type of filter material-- -C -Depth of filter material_____ r� r y -------Total length-- ---------/f ------------------ Seepage � t Pit: Distance to nearest well-.-. --------- from foundation---------*---------Distance to nearest lot line--------------_-- 1 !� ❑ Number of pits--)-- - --------------- -------- -- Lining material-- ---_- ---------Size: Diameter-- ----------- --------Depth---------- ----------------- Cesspool: Distance from nearest weli-----------------Disfance from foundation ------------------ J I -- __.Lining material------------------------------------- 0 Size: Diameter- -�--------------- ----'------------Depth- ==- - ------- --------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------- from nearest building 9 - ---------------------------- ❑ Distance to nearest lot line-------------------------------°•---------------.-- Remodeling and/or repairing (describe):_.-:_____------- ------------- ---'- ----------------- ---------------------------- -- --------•--------------- --------•------- - -- --------------------- ------------------------------------ ----------------------------------------------------------------------------------------------- ------------------------- - ... I hereby certify that I have prepared this application and•fhaf 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. -_ Si ned _ _ _:_ : : ------- ------ ------------------ -----(Owner,and/or,Contracttorr) ---------------------------------------- -- -- (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-- J ._ ---- DATE------ 1? — -------- �----3-- ---6-s___�.------ REVIEWED BY ----------------------- -t -- - - - --------------------------------DATE------_- ---- UILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------• DATE-------- ------------------------------ Alterations and/or recommendations:--_- i . - t ---- ----- ---------------- FINAL INSREC ION B r Date_------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 Wes!9th Street Stockton,California Lodi,California Manteca,California Tracy, California F.RC Q.