10734 - Laserfiche WebLink

Home Browse Search

.�e� �ri � Bio �-r v'_f L � s L w .. . APPLICATION FOR Permit No. SANITATION PERMIT �j, /� (Complete in Duplicate) Date Issued tA)_1--'Y_ 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 AND LOCATION--- =;/�� ------`T--- ---------- ----------- Owner's Name--- I��---------�--d.0` .t3_,V-1y---------------------------------------- - -------------------------------------------- Phone--------------------------------•--- Address---------------------- X3'k,1t'h_-RP-T ------------ •-----------------------------------------------------•-------------------------------------------------------------------------------------------•- Contractor's Name-------„ f ----- /t f J Q � - --------------•--- Phone.A{o -2114 Installation will serve: Residence A Apartent House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -1----- Number of bedrooms __ Number of baths __(--__ Lot size -----A-_a' ----------------------------- Water Supply: Public system ❑ Community system ❑ Private 1� Depth to Water Table _' 4 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam E❑ Clay ❑ Adobe.4 Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation-------------------.Material_--__--------_..____._.____-_----------.-_--.---- ❑ No. of compartments-- -------------------_Size--------------------------------Liquid depth----------------- --------Capacity----------------------- , r Disposal Field: Distance from nearest well--yvr'_-_.._.Distance from foundation__ _p_____________Distance to nearest lo} line_ 's�_ _________. 19 Number of lines--------------I------------------Length of each line_------��-------------Width of trench----A_y_II------------------- Type of filter material---g@C ----_Depth of filter material___ ----_---.-Tota€ length-------7j—'------------------------ Seepage Pit: Distance to nearest well----------------------Distance from foundation------------........Distance to nearest lot line------------------. ❑ Number of pits----------------------Lining material-----------------------Size: Diameter---------.-------------Dept h----------_---------------------- Cesspool: Distance from nearest well-----------------Distance from foundafion-------------------.Lining material-------------- _.------_---_-._._. p\ ❑ Size: Diameter-y---------------------- ------------Depth-------------------------- ------ ------------------Liquid Capacity----------------- ----------gals. N ' Privy: Distance from nearest well____ ________________________________________._Distance from nearest building.-------------___--_-------__Y______.-. ❑ Distance to nearest lot line--------------------------------- --------------------------------- ------------------------------------------F------------------------- Remodeling and/or repairing (des 'be): - -------- '=------------ -------------J_ ------------ If_r------------------------------------------------- -------------------------------•--------------------------------------------------------------------------------------------------------------- F< -------------------------------------------------= - ----------------------------------- -------------------------------------------------------------------------------------------------------------------- --------------------------------------- I -------------------------__----------_--------__. _--_-----____------_--.___-------_----_-____-_______-_--_-_-___----_-__--------------_---------_______--__-_---__-_-_-__-_--_----.. . 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 d regulations of the an J0 uin Local Health District. t _ c (Signed)------------- --------- ----- t------ ------ -------------------------------------- (Owner and/or Contractor) By:---------- --------- -----------------------------------------------------------(Title)---- eA_Z1'�---------------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). M FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY---------------------------------------- -------------------------------------------------------- DATE----------------------------------------------------------- REVIEWEDBY------------------------------------- --------------- --- -------------------------------------------• DATE------------------------------j,_ -------•-------- BUILDING PERMIT ISSUED----------------------------------- DATE Alterations and/or recommendations-------------l r -------- ------------------------------------------------------------------------------------------------------------- <------------------------------------------------------------------------ ---------------------------------------------------------- ------------------------ --------- -- --- - --------- ----- ------ ---------------- ---------------------------------------- ---------------- --- - -----AJ _ b FINAL INSPECTION BY:..------- . - - Date - ----------------- - ------------- : I --------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street r 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M , Revises 1-57 F.P.CO.