9320 - Laserfiche WebLink

Home Browse Search

'1 \\ APPLICATION FOR SANITATION PERMIT Permit No. ............Z....C, 1�a (Complete in Duplicate) �/ �WADate Issued ---_.� 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 AN LOCATION - --------------- - / Owniar's Name______ Phone,J _f2`_ / -•-• ••-- ----- -•••• -----;------------------- ------------------------------------------ ------ ---------------- Add ' - Address ( � � - Con rector's Name ZA��C•�t Phone -. - 7 Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Tr//ail r, out ❑ Motel ❑ Other Number of living units: _®_ Number of bedrooms -�- Number of baths/-A, ----/ i Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table' ft.. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay [__1 Adobe ( Hardpan Previous Application Made: Yes ❑ NoNew Construction: Yes ❑ No] FHA/VA: Yes No 12" TYP� 011INSTALLATION AND SPECIFICATIONS: / (No septic tank or''cesspool permitted if public sewer is available within 200'~feet.+ Se t)c Tank: Distance from nearest well-115410 from foundation p / / !•Q.---•------.Materia.........�'--- -----------•-- -----•- (� No. of compartments-------I---__--t Size__�fa•�_.34_.___Liquid depth:_.___. __-_____Capacity.__�4�__ ` Disposal Field: Distance from nearest weII�Q--------Distance from foundatiot��[�__----------Distance to nearest 6t line P . Length of eadf4lm-*___ 1.?...........I .�A%ic t i o trench `� �` Number of lines -:- . --. ._-_ }/ --- - Type o f7tee me'#erial.___ :Dep-fh of #iffier''mat'enat_.__:- `�:_--Total length______________c.�G� Seepage Pit: Distance to nearest ell-/d'n---------Distance fo dation___S.1_[f__.___.Distance to neatest lot line_.��_ Number of.pits- _-�----_-_-__Lining material_ Size: Diameteri �� p Cesspool: Distance from nearest well_____-_____-_-__Distance from foundation-_-__--------------- .__.Lin.in,9_=te�i�.�...,___ ______________________ ❑ Size: Diameter------------------------------ --- ---Depth----•-----•- - ----- ---- - - --{_._Liquid Capacity---•---------------------gals. Privy: Distance from nearest well------.......... .-----------------------------Distance from nearest building-----------------------------;-___---___- C11% [] Distance to nearest lot line---------------- ------ ----- ------.................... --------------- - ------------------ ---- ------------------ Remodeling and/or repairing (describe) ---- -•----- -t -------..... ................................................ .................--------- -1.... ---- ------- ---- ---- --------------- ---- ---- -----• -- ----......................•-------•---- .._ ---------•------------------------------ -------- -••-•----------_----------------•----• --------------•--------- I hereby rtify that I have prepared this application and that the work will be done ih accordance with San Joaquin County, ordinances, to laws, and rules mid regulations of the San oaquin Local Health�Disfrictj �i (Signed)------ --�`�"---=----- ---------- A G Owner and/or Contractor) �Y� s� ------ ----- ----------Tit -------- -- -------- ---- ---------- (Plot;plan, showing size of lot, location of system in relation wells, buildings, etc.:, can(bei placed on reverse side). ' FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_----------- ----------------------------------------- ----------- DATE__�j ----- REVIEWED BY--------- ------ -- ----------------------------- ---- ATE -,e---------- BUILDING PERMIT ISSUED------_---------- --•------------------- --- ----- DANE-.-------- R ----------`---------- •---•- Alterations and/or recommendations:.. --------------------------------------------------------------- •------•---- •- - ' ----- - -- --RC1 ._-----•. - ----------------------------------••-•. ---------- --------------- ------------------ --......-----------......-------------------------------------- ---------------------- _ E ---------------------------------------------------- FINAL INSPECTION BY:.,------ ----------_-------- --------•-- Date..-- II------ ------------------- -------------------------------------- 7 SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C' Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 1.57 FY,CO.