11795 - Laserfiche WebLink

Home Browse Search

4 a APPLICATION FOR SANITATION PERMIT Permit No. 7 ........ L n (Complete in Duplicate) This Permit Expires 1 Year From Date Issued Date Issued . _ -� Application is hereby made to the San Joaquin Local Health District for a permit to cbnstruct'and"ii taH`the•work herein described. This application is made in compliance wifh County Ordinance o. 5 9. / _ """_._JOB ADDRESS AND LO ATION_____:__ ___' ----------- ------------------•-------------------------+------------------------- A&V Phone-------------------------- Owner's r Name------------ - - ------------ --------------------- --------------------------.-------------------------4-------------------------------•------------- ------•----•--Address Contractor's Name------------------ " ----------••-------------------------------------- - ---------•--- Phone-----------•------•---_--•-----_ € Installation will serve: Residence LA�parfmen'f House ❑ Commercial ❑ Trailer Court'e❑ Motel ❑ Other ❑ Number of living units: Number-of-bedrooms"_- _- Number of baths __/--_ Lot size p j?'a Water Supply: Public-system V<Coriimunity-system,❑ Private ❑ Depth to Water Table Character of soil to a depth of 3 feet:\.Sand ❑ Gravel ❑I.Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe g;-<ardpan ❑ Previous Application Made: Yes ❑ N6,090'0'_New Construction: Yes ❑ No FHA/VA: Yes ❑ No [4. TYPE OF INSTALLATION AND SPECIFICATIONS: :� R (No septic tank or cesspool permitted 4'public sewer is available within 200 feet.) j Septic Tank: Distance from nearest well--------______"_Distance from foundation___________________Material--"""..__""""_..-_-._-."_.----------------_,__--.- No. of compartments-------------------- -----Size--------------------------------Liquid depth----------------- Capacity _...._._ ----------------------- Disposal Field: Distance from nearest well_________________Distance from foundation--------------------Distance to nearest lot line------°.......... �G"i/y❑��//�r� Number of lines------------------------------ -----Length of each line------------------------------Width of trench----------------------------------- 1 q Type of filter material- -____"--------------Depth of filter material`--_r_- .---___-_"..Total length------------------------------------------ Seepage Pit: Distance +o nearest well. .____-_--Distance from foundation__"--------D fT nce to nearest lot,line__r0__" """."_ Number of pits_._._,--�- -Lining material._/_G4eA--"_.Size: Diameter__ a?___ p Depth -- �j 4-- ,-------------- Cesspool: Distance from nearesf.well------------------Distance from foundation------------------__Lining material------------------------------- r ❑ Size: Diameter------------------------------ Depth =----------- ----- ------------------Liquid Capacity----------------------------gals. 1r�I i Privy: Distance from nearest well_-_----------------------------------------------Distance from nearest building"_."-____-__________-__-""._-""__".". ❑ Distance to nearest lot line------- ------- ----------- ----- ------------------------------:--------------------------------------------------- t Y Remodeling and/or repairing (describe):______.__-______._ - r1/f --------------•----------------------------------------------------------- ------------•---"---------------------------------------------•------------------------------------------------------------------------------------------------------------------------------------------------- -- --------------------------------------- --•------------------------"----------•-------•-----------------------•-•----------=-------------•----------------------------------------------------------------------------------- --------------------------------------------------------------IY--------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that 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. (Signed)----------------------- xvk-" --_------((7Sy.0 Contractor) (Plot plan, showing size of lot, location of system in ation to wells, buildings, etc., can(beleplaced doonc reversesde). —,_.FQR-DEPARTMENT-USE ONLY APPLICATION ACCEPTED BY------- A. --05 DATE----C REVIEWEDBY-------------------------- '' ------ DATE----------------------------------------- BUILDINGPERMIT ISSUED--------------•------------- --=-----------------------------—-------------------------------------- DATE-------------------- ----------------:--------- '--------- Alterations and/or recommendations-------------------------------------------------"---------------------------------------�-------•=--------_"�-'------------ --• _;----------------- --------------- -------------------f ------ - --- V -----•----------------------------�-`� z. .C,4�------ <a• , ------------ -- - --- ----------------- -.�-� FINAL INSPEC � _ ._. .- _ - - -_- -- ----- Date..... ----- i SAN JQAQUIN LOCAL HEALTH DJSTRICT 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 Rcvfsed 8.'59 F.P.Co.