8861 - Laserfiche WebLink

Home Browse Search

Permit 14 APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Date Issued ____?'ZW✓.4 Application is hereby made to the Sa'n 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 AND LO--C ION_-- - Phone--- 3� Owner's Name_____ W - T ._Y `- -- ---------------------------------------------------------------- Address -------------•------- Address-----•A ---- ---- � ________ - ------------- --- --------------------•----•--- Phone----------------------------------- Contractor's -- ---•- Contractors Name__ Other ❑ Installation will serve: Residence No Apartment House [I Commercial ❑ Trailer Court ❑ Motel ❑ Number of living units: --� Number of bedrooms __3___ Number of baths __�__-_ Lot size ____- ^��`"----------------------------------- Number -------------------•---------- --- Water Supply: Public system ❑ Community system ❑ Private ® Depth to Water Table 5.9-_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ® Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No N New Construction: Yes ❑ No M FHA/ ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or`cesspool permitted if public sewer is available within 200 feet.) . _a _ Material------------------------------ Septic Tank: �e from nearest well__________-__.__Distance from foundation_-.________ ___- N f compartments--------------------- ----Size----------------- ----•--- ---Liquid depth-------------------\----Capacity----------- -----. ❑ � -- Disposal Field: Distance from nearest well--7 --___._Distance from foundation__30 ----------Distance to nea'rest lot sine_J'______-___-. `1 Width of trend ----------------- J Number of line -----------_ _ ______Len tb of each line -------------- - 9 r -------------- ))�v/ C. -------De Depth of filter material-� ----'------- Total length-_-"�2�1--------------------------------- Type of filter matenal_l.___ _ - p � 1 a.___..__..-.Distance to nearest lot line------------- Dm Pit: Distance to nearest well___d_lt�' - Distance f fo ndation__ -- - Number of pits----- -----------Lining material._ _/- --G--- --- -.Size: Diameter----�-------------Dept -�-------- Cesspool: Distance from nearest well_______________`-Distance from foundation_-_________-_.____Lining material________.._.___.____-____�_`G_�___. Size: Diameter------------------------- ------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. ElDistance from'nearest-building----------------------------- Privy: Distance from nearest well------------------------------------- ❑ a Distance to nearest lot line----------- --------------------- ------------------------------------------------ '' ' ---- -- - ----------- Remodeling and/or repairing {describe):__--_- ----- - -- -- ------ -------------------------------•----------- --------•-------------------------------------------------- ------------ -------- n ----cor c ----a ---qui I hereby certify that I have prepared this applicationhe San Joaquin h work cal Heawill l kepis ne i accordance with San Joaquin County ! ordinances, State laws, and rules and regulations o q ' -----------------------------------------(Owner and/or Contractor] - t Title - ~ By--------------- -------------------------------------------------------------------------=-----------------•---------------------[(Title) 1 (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). F FOR DEPARTMENT USE ONLY 74 APPLICATION ACCEPTED BY-- ------_ - -- -------------------- -------•--• DATE-'r-- ------------1 J ---- ----------• ---------- ----. DATE---•-------------------=----------...----------••---------- REVIEWEDBY------------------------•--------------------------------------------------------- -- --- BUILDING PERMIT ISSUED-------------------------------------------- -------------- DATE Alterations and/or recommendations------------------------------------ ----------------------------------------- --------------------------------- ----------- --------- --- C� ._ Date-------- -5---�-------------------------------------------------- FINAL INSPECTION BY--------- -- - - -•----- �" �� (,— SAN JOAQUIN LOCAL HEALTH DISTRICT 132 5 camore Street 814 North "C" Street 130 South American Street 300 West Oak Street Y Stockton, California Lodi, California Manteca, California Tracy, California ES-9-21x1 , Revises 1.57 F.P.CO.