3117 - Laserfiche WebLink

Home Browse Search

F _ 4 _ APPLICATION FOR SANITATION PERMIT, Permit No.-,;:__�__(---__7__-- I (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-Cis made in compliance wi h Cou�ty Ordinance No. 549. ti / 3-� Aux JOB P;bDRESS A LOC TION: -------- -------= ------------- —13 0 ------ ----v s Owner's Name--- J ------- -- -------- ------------------- -" ------- -- - ----- Pone f? % IAddress------ - - ------------- !1 <P..�--------------------------------------------------------------------------- - --- `� - ,`.. ---------- ------ Contractor's Name---- ----- ---•- ------------------------------------------------------------------------------------------------- Phone----------------------------------- a Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer I__ er Court E] Motel p OAer E-]Number of living units: :_____ Number- of bedrooms ---& Number ,baths ----!___ Lot size ___ �_o_____X__��____________-__ � Water Supply: Public system El Community system F] Private Depth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand Gravel Sand Loam ' Clay Loam Cay Adobe" Hard an P ❑ ❑ Y Y ❑ Y ❑ p ❑ Previous Application Made: Yes ❑ No 12/ New Construction: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public ewer is available within 200 fee+.) r Se tic nk: Distance from nearest well --_----- �(�-______.Materi i p � � -_Distanrre fr �oL fFion______ ____________ ______ No. of compartments----------- _ r__ q r p y._ "___ -__Sized�__ __x__________Li uid de th H'- _____-___Ca acit ___ �Q I.M Dispos Field: Distance from nearest well Q._ - Distance from foundationt_!__ _ ___--t_Distance to nearest lot ine Number of lines______,_____ _:___-__ _ Length of each line________�? _`7 Width of _ __-. t_{' Total len th -------------Type of filter materidl _ "f; l]dpth of filter matenal_________f g R _ 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___________________----_----- ❑ Size: Diameter--------------------------------------Depth---------------------------------------- Liquid Capacity----------------------------gals. l Privy: Distance from nearest well_____s.__-________________________._____________Distance from nearest building__-._-._ _ --------__________- ❑ -„_,,,..-,. -- ,.--:, _-- ----------------------------------------------------- a3 Distance to.nearest lot line --'-'"`” --- ------ -- -------- - -- -------- -�F - ---- Remodeling and/or repairing (describe) ---------------------------------•---------------------------------------------------------.-.--.------------ ----------------- ----------------------------------------------------------•------------------------------------------------------------------------- ----------------------------------------------•---------------—---------------------- ------------------------------------------- ------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------ I hereby certify that I have prepared this application" d that the work will be done in-accordance with San Joaquin County ordinances, State la p4nd rules and r Joaquin Local Health District. (Signed)------- - -- ___ ------------------------------------------------Owner and/or Contractor 10 x• (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- ---•----------------------"-------------------------------------------------------------------- DATE�___-------------------- - REVIEWED BY------------------------ - -----------------------=-.-----------------------------------------.--- -=------ DATE- - Z- BUILDING PERMIT ISSUED- --- ----------------------------------------------------------------------------------- DATE------- - Alterations and/or recommendations:----_ -- ! ---------------------------- ------------------------------- ---- ------ � � c�- , 4 -------------- - �! A --------------------------------------------- r = _ =x i-011 'FINAL I.NS^PE -IO;W BY:---------------------------------------------------------------- Date------------------------------=- ------------------------------------------..... SAN JOAQUIN LOCAL HEALTH DISTRICT X130 South American Street 300 West OakStreet132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES--9-2M 8-51 Revised W-2100