4279 - Laserfiche WebLink

Home Browse Search

� APPLICATION� • ATION F4R SANITATION PERMIT., Permit No. - , (Complete in Duplicate) Date Issu d --. _.�_'� ---� � 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 in compliance with County Ordinance No. 549. -----•- ----------------------------------- JOB ADDRESS A D OCATI N--- �I-�.�----- -'---- -- •- ----••-------•-------- ------------ - Q ` ' Phone_ /--`------ Owner s Name-- ----- -- --------------•----- - --- ------------------ 5 --•------------•--------------•---------•----•-----------•------------•--------•---------- Address---------------�---` `—-------- ,---- ------- -------------- f f� ---"-------••----------"---------------•------------------------•-•-- Phone.. Name--.--2--._ .._ +`- !' " -- --- -------------- Contractor's ' Installation will serve: ,Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Ocher ❑ • p i ------------------------------ g ! Number of baths ---L- Lot size- ri Number of living units: -- ---"- Number of bedrooms -!4-private Depth to Water Table _I-Q ft. Water Supply Publics stem Community system ❑ ❑ p Character of soil to a depth of 3 feet: Sand El Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Er Hardpan ❑ Previous Application Made: Yes ❑ No New Construction:'Yes �o ❑ I TYPE OF INSTALLATION AND SPECIFICATIONS: , (No septic tank or cesspool permitted if public sewer is available within 200 feet.) _Distarnc from foundation_-_ __ - Material----- ----- ---------------------"--"-- --- Septic nk: Distance from nearest well____- """" """ Q I Nc. of compartments __Siz - it.-�r---�� Liquid deptha -Capacity----1_!�O'_ a p �to-�� Disposal Field: Distance from nearest weli__fR...Distance from fo ndation_--___4-0 ---Distance to nearest lot line _____________� $ r/ I r," Length of each line....... jjrlT .Width of trench _ --- r Number of lines__----------- --"---- De th of filter --------_ -------Total length-------------------------------------� --- ` Type os filter material___ ___( - -- p ----- See at: Distance to nearest-w ll______- -----Distance from oun ation____�0-------Distance to nearest lot ___----- -- c� 3 -------.Depth__: Number of pits._______.-1-_____----Lining material_- -."----- size: Diameter______________ , Cesspool: Distance from nearest well________________°Distance from foundation-_.._______-`____.Lining material________.__."----- els. Depth_ Liquid Capacity----------------------------g ❑ Size: Diameter-------- ---------------------=- --------------- 1 Priv Distance from nearest well_____:..____----------------- ------------------Distance from nearest building--------------------------• Distance to nearest lot ine:----------------------------- - - --------------- Remodeling and/or repairing (describe):---------------------------------------------------------------- ------------------- - ------- -------------•-----------------------------•---•---- •------•------ - - - --- r ` • K ` epared thin application and that the work will be donein accordance with San Joaquin County I°hereby certify that l have pr rules and regulations of the San Joaquin Local Health Distric+, ordinances, State laws, and (Signed) -------------------- ---(Ow� r Contract r and/or or 9 --------------------- t (Title)_.- -- ----- -------------------------------------- sy:. - .----------- ------ (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 t""�: p; f`- '� ------------------- EWE PERMIT ISSUED.-------- -- -- --------------- ----------- DATE --•------------ : REVIEWED BY " ----------------------------------------- BUILDING Alterations and/oe recommendations:------------------------ -------------- ---•--------------------•--------"-----•------- -----•"------------•----------•-•----•------------- --------------------------- •---•--- i rj�------------ FINAL INSPECTION- BY::.---.:=__-__-. ••---------------------------- SAN --•=------- - - - -----------"" Date---=�----------- - --- SAN JOAQUIN LOCAL HEALTH DISTRICT l32 sycamore Street $14 North "C" Street 130 South American Street 30D West Oak Street Y 'frac California Stockton, California Lodi, California Manteca, California Y' LS-9-2M 10-52 Revised W-2100