10888 - Laserfiche WebLink

Home Browse Search

- r APPLICATION FOR SANITATION PERMIT Permit No. ,ll.�_�' r; (Complete in Duplicate) 1 }� pate Issued .----_-L--_/ Application is hereby made to the San Joaquin Local Health District for a prmit to constryt�t�and insta he work herein de Abe This application is made in compliance with County Ordinance No. 549. Gi ] JOB ADDRESS AND C TION- -.-______-------fir.- 3 Owner's Name--- ----------------------------------------------- ---------------- Phone------------------------------------ Address----------------- --------------_--------------------------------------------- Contractor's Name------------------------------------------------------------------------------------------------------------------------- ------------------ Phone----_-----•-----•----- Installation will serve: Residence ❑ Apartment House ❑ Commercial E] Trailer Court E] Motel ❑ Other, Number of living units: _1-_.-- Number of bedrooms _/-. Number of baths .l__. Lot size __6_0----- -__6-11------------------ Wafer Supply: Public system ❑ Community system ❑ Privateer Depth to Water Table _J_ . Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes)9N ❑ Ne Construction: Ye� No E] FHA/VA: Yes ❑ No , ri TYPE OF INSTALLATION AND SP I ATI NS: t_1 (No septic tank or'cesspool permitted if public ewer is available within 200 feet.) Septic Tank: Distance from nearest well- ____Distance from founder?ion--- - ----------Materiai-- - - _ -__---------.__---- No. of com artments- _ -Size---� - 3---Li Liquid de th__---_y Capacity �iQ-� --_ P v� q p Y Dispos I Field: Distance from nearest YSell_ - -_ _-�---Distance from foundation___`-ee-/ Distance to nearest lot line___ - Number of lines---------�-----------------------Length of each line---------------------.Width of trench----- ?-- �- -- - --------------- Type of filter material------ ------------------Depth of filter material-----------------------Total length--_-_-_--------__---_-__---_-_--__--- 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. Privy: Distance from nearest well------------------------------------------------- from nearest building------------------------------------------ 0 --------__- -----_-----__------------.--.❑ Distance to nearest lot line-------------------------------------------------------------------------------------- �emodeling and/or repairing (describe)---------------------------------------------------------------------------------------------------------------------------------------------------------- !^I--------------••-------•--------------------------------------------------•-------------------------------;---•-----••----------- --------------------•------------------------------------•-------------------------------- -------------------------------------------------------------------------------------------------------------- -----------------------------------------------------------•---------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat laws, and rules and regulations of the an Joaquin Local Health District. [Signed):r -----------------------------------------------------------------(Owner and/or Contractor) Ely;............------------------------------------------------------------------------- ---------------------------------------------(Title)------------------------------------ -------------------------- (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 `43';�-D - BUILDING PERMIT ISSUED---------------------------- -------- ------ -- --- ------ - --------------------- DATE--------------------------------------------- Alterations and/or recommendations:--------° t- ------------------------- --------------------------------------------------------------------------------------------------- ------------- ------------------------------------------------•-----•-------------------------------------------------------------------------------------------•----------•-------------•----------------------------------- ----------------------------------------------•-----------------------------------------------------------------------------------•------------------------------------------- ---------------------------------------------- --------------------------------------------- Allcl- FINAL. INSPECTION BY:. - ------------ ---------------- Date ------- - - -------------------- --------------•--------------------- SAN JOAQUIN LOCAL HEALTH DISTRIC 130 Soufh American Streat 300 West Oak Street 132 Sycamore Street . 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9--2M Revises 1.57 F.P.CO.