3922 - Laserfiche WebLink

Home Browse Search

Pia init•`No, 3 - �-•� -.. APPLICATION FOR SANITATION PERMIT --------_ (Complete in Duplicate) Date Issued --- '�! �`-i < 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 incompliance with County Ordinance No. 549. r ca1Y. -.... ------ • - - --------------------------- JOB ADDRESS AND LOCATION __.--�-�---_/--�,------ �- -- - y !�e • ply .!/.._!_ -- -------------------------------- Pone Owners Name--------------------- ; Phone �6 �/ - , �h �------------------------------------ Address---------------------- ------------o�-'f9�y_ ----------•---------------•---------------------,------• ------------ Contractor's Name--- --------If---------•--•------•----- ------•-----------------------------------------------------------••------••-------•----- -------:----- Phone-----------------------------•---- Installation will serve: Residence M Apartment House ❑ Commercial ❑ Trailer Court ❑ Mofel [3 Other ❑ Number of living ung ` g its: -_� __ Number of bedrooms . _-. Number of baths .______- Lot size ___ > ---1--J� ___-_______--------------- A Water Supply: Public system [Community system ❑ Privateiff Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy Loam El Clay Loam Ll Clay ❑ Adobe® Hardpan ❑ Previous Application MadeIi: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION:!I AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 11: Grp-..r Septic Tank: Distance from nearest well__-_#.tom---Distance from foun�tion_la- ____.._.Mate ' '- ----------\ Size_.. Li uid•de th------ - ------ -- Capacit ------ ® - No. o I,j compartments---__-_-� --- �� .�-- -- q �' Y--• �.� ._?-_______.Distance to nearest lot lirieJ__ ___________ Disposal Field: Distance from nearest w 11_________________.Distance from foundation__ `f ® Number of lines------------- --- ----- ----Length of each line-------ra-_6--- Ir----Width of trench-------�-----------------------\� � Total length------/2—Q----------------- �1 Type of filter material___�,�- --_Depth of filter material ___.___ ill Seepage Pit: Distance to nearest well---------------------- from foundation___________________.Distance to nearest lot line-------------- ` ❑ Numb from nearest well-----------------Distance from. foundation----------ter----------------------..Qepth____...__-__________-_---------- er of pits---------------- -----Lining material--------------- Lining material ---- Sze: i Cesspool: Distance , ❑ Size: Diameter--------------------------------------Depth----------------------- Liquid Capacity gals. Privy: Distance from nearest well---------------- ---------------------Distance from nearest building----------------------------______.__ .. ❑ Disfance to nearest lot line-------- -------------------------------------------------------------- -------------------------------------------------------- ------------- Remodelingand/or repairing (describe):-----------------------------------------------------------•-----------------------------•------------------------------------------------------ ------------------------------------------------------------------------•------------------------ -- j - - -w --- ------- - -------- ------------------- � ------- -------------------------------- - -- - •-------------------------------------------------------- ------------------------------------------------------ I hereby certify thatjl have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State law , and rules and regulations of the San Joaquin Local Health District. V. ----- ____________________(Owner and/or Contractor) {Signed}_ x Title (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). O RTM NT USE PNLY .9 DATE------- - -- d ----------- APPLICATION ACCEPTED D BY - ---- ' REVIEWG PERMIT ISSUED-------------------------------- ------------------------------------------ --------- - DATE-------------------------------- ----•------------------- ------------------------------------------------------------------------•---------------------------- DATE . Alterations and/or recommendations:------------------------------------------------------------------------------------------------- -----------------------------------------*--------------------- -------------------------------------------!I ------.---------------------------------•------------------- II ----------• -----------------------------------•----- IM ----------•- -----------------------------------•--- ---------------------------------------- ---------------------•-------------------------------------------------------------- dl ------ /4 FINAL INSPECTION BY------------------ Date------------------- T-- ----------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton. California,l Lodi, California Manteca, California Tracy, California 4 ES-9-2fM 10.52'Revised W-2100 a-