11905 - Laserfiche WebLink

Home Browse Search

IIt APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Dat f e Issued - - _� Application is hereby-rnade to the San'Joaquin`Local Health District for a permit to cons t�uct and install the work herein cribed. This application is.made in'„compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION___ / ” .. -- Owner s Name----------------- ' ., �: 5-------_---- r �.— -- P Condi actor's Name-_ �. :�� e - ----- - ! ! k J' ,I f ----- -{ -------------- - - --- ------------------------------. Phone------------------------ e --.. __________ _ Installation will serve: Residence i partment House ❑ Commercial ❑ Trailer Court ❑ Motel Other ❑ Number of living units: _ ____ Number of bedrooms l Number of baths _--_---- Lot size _----------- --- ------ ------------- -•----------- Water Supply: Public s stem � . y ❑ Community system ❑ Private Depfh to Water Table f0-_ ft. Character of soil to a depth of 3 feet:' Sand ® Gravel ❑ Sandy Loam Clay Loam ❑ Clay n Adobe❑ Hardpan ❑ ' Previous Application Mada11 Yes ❑ No K New Construction; Yes No ❑ PHA%VA: Yes ❑ No ❑ TYPE.OF INSTALLATION-AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.)r Septic Tank: Distance from nearest well" t ___'_Distance from founif lv t ion Mance,nal-------------- t---------. ( No. of compartments---- ---------- ---Size�dX-_ -x-}--__-_Liquid depth-- Capacity-/,' -/.� Disposal Field Distance from nearest weii.611----------- Distance from foundation d- -- ---.- .Distance to nearest lot line- --- ine- Number,of lines___- --____ ___-_--"-_ _ Length of each line-----_��_ -'P,}= �n�Width of french-"•1 Yf Type of.;filter material-S—M - - �i --------- ------ -- . I Depth of filter material---,�- --_-_--- � -- 7otal length___--___� ____- Seepage Pit: Distancezlto nearest well--------------=------Distance from foundatio -------------------- line ` Size: Diamefer------ ----------------.Depth---------------------------------- Cesspool: Distance from nearest weft"----------------Distance from foundation--.--.-- .-____lining material__---_---__-------.--_-."-_.__ ❑ Size: Diameter-------= ---.. --_---------Depth----------------- ------Liquid Capacity------------------------ --gals. Privy: Distance'�from nearest-well -'--- --------- T g-------------------------- - ,� � ___________ _ �_--Distance from nearest building ❑ Dlstancelto nearest lot'line. _-_--" _. -- ----------- r --------------------------------------------- - -------- ---------- ------------ describe):-_-Z-- -=---- --' _. --------- = d---------------------•---- ----------------------------- - ------------------------------ --------------------------------------- -------=-------------------------`-,--- -=------------------- ------------------------ ' 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 reg ations of the San Joaquin Local Health District. a �� ;¢ -� h (Signed) -------- --- -- , { By=---------- '� . caner i - " = = --------------------------------------- (Plot an -- -----------[Title) plan, showing size of lot#'lots+ion of system in.relation to wells, buildings, etc., can be placed on reverse side). �f. ii F DEP IN USE ON APPLICATION ACCEPTED BY--`-- -- --------- €. 00 REVIEWED BY---------------- -- - ---------- -ATE-- -- l I --------------------------------- ------ - ---- DATE = ----------- BUILDING PERMIT ISSUED.---=g-----------------------------% - ------------ -----------. DATE--------------------- - AI}erations and/or,recommendations:-__'--'-.>_._-�'�_ ------------ ---------- ---------------- ------- -------------------------------- ---i --------------------------- - --------------------- - ------------ ----------•-------- -------------------------------------=-----------•------------ FINAL INSPECTION' BY:----- -----�----- ----- -- - ------------------------ Date- T _____ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300.Wes+ Oak Street 132 Sycamore Street Stockton, California 814 North "C- street Lodi, California # Manteca, California Tracy, California ES--9-2M , Revised 1-57 F-PCO. L