10364 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. ge �. _ (Complete in Duplicate) Date issued ----_- � } i Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This applicatiori is made in compliance with County Ordinance No. 549. �� /x_ l�fiir.� - " JOB ADDRESS AND LO ON �� 3 �/1 �P1�•61'-------------------------------- --`� �N�.fvh Owner's Name----- ---- - -�- -------------- Phone------------------------------------ ----------------------•----•-• ---------•---•----- ------------- -------------------- -- Address-------l� � '� _A ,,----------• ----------------------------------------------------- ------------------------------------ Contractor's Name ---- Phone.. � 5� .� Installation will serve: Residence N Apartment House ❑ Commercial ❑ Trailer Court ❑ Mofiel ❑ Other ❑ Number of living units: _-I"--- Number of bedrooms 3_-_ Number of baths _-I--- Lot size ------7 ------------------------- Water Supply: Public system ❑ Community system [R Private ❑ Depth to Water Table __yeft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe® Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes 54. 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__Na Ce--_--Distance from foundation---- ------------Materiai__'_?�4 -- W_qAC1 No. of compartments------- ----:X'--------Size----- ------Liquid depth---------y--------------Ca acitY•----�-----�-------0- -------. -�---- Disposal Field: Distance from nearest well"9_Atf_ _-Distance from foundation--M-7----_---_---Distance to nearest lot line--47----__-_- Gl Number of lines_-_-_--__---d�"---------------Length of each line------7�_-`--__----___----Width of trench--_Xy'_-------_-_-------_-_ { Type of filter material---jock----------Depth of filter material-----18-- -----------Total' length----Ise`a---------------------------- $� r ' Distance to nearest well -.-___-_Distance from foundation-�__-_.. ----.Dis#ante to nearest lot line-S------- -_"'°`` ® - 1?0 -------Size: Diameter---- p 0 Number of pits. �----------Loring material-=- ----- --�- Y�=-� --�----.De th -V-- ---------- - Cesspool: Distance from nearest well-"---------------Distance from foundation--------------------Lining material------------------------------------- ❑ Size: Diameter--------------------------- --------- Depth--------------------------------------------------Liquid Capacity- --------------------------ga{s. C13 Privy: Distance from nearest well------,-"----------------------------------------Distance from nearest building------------------------------------------ ON ❑ Distance to nearest lot line---------------------------------------------I---------------------------------------------------------------------------------------------- Remodelingand/or repairing (describe) =------------------------------- ---------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------ ----------------------------------- - - ----- --- -•-- ------ -------------------------------------------------------------------------------------------------------------------- ----------------------•------------------ 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 regulations of the San Joaquin Local Health District. Ig I i (Signed) �'kei3 5� e �� C�/"-�l��------------------------------------------------------(Owner and/or Contractor) J By: --�--------- --- -- -- -- -----------------------------------------------(Title)-------- ------------------------ (plot --- ------------ --- (Plot plan, showing size,of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). i ►� FOR DEPARTMENT USE ONLY ,.tri � . r I APPLICATIONACCEPTED BY------ ---- ----------- --- -`-'-- ---------------- -------------------------------------------- DATE -- I�- _�� -------- IREVIEWED BY-------------------- -------------------------------- - DATE- ---------------------------------------- I BUILDING PERMIT ISSUED------- ------------------------------------------------------ DATE Alterations and/or recommendations----------------------------- --------------------------------•--------------------------•--------------------•--------•--- ------ r -----------------•--------•----------------------------•--------- --------------------- -----------------------------------------•-•--- ---------------------------------------------------------------------------------------------- ------------ f FINAL INSPECTION 9Y-1------- Date--- SAN JOAQUIN LOCAL HEALTH DISTRICT j 130 South American Street 300 West Oak Street — 132 Sycamore Street 814 North "C" Street Stockton, California Manteca, C-aalifo�a Tracy, California f r i Lodi, California y ES-9-2M . Revised 1.57 F-P.CO. i r