8170 - Laserfiche WebLink

Home Browse Search

.. APPLICATION FOR SANITATION PERM T '7Permit No.. .1.1_7e...... 1�1 -- t (Complete in Duplicate) ' ) Date Issued Applica}ion 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 com liance with County Ordinance No. 549. �•�fi-r ,,,�Gt�✓ JOB ADDRESS A D LOCA-riON t'-�'-u"-=-- 4� �#- - ' - --- --------1 f� zz sE Owner's Name_.. < Phone. Address.---.---��a � ---- --- -- - --------=--------------------------------------- -•------ •--••------------------------------- ------------------- Contractor's Name--------•---��c4[f=------------------------------------------------------ --------------------------------------------- Phone----------------------------------- Installation will serve: Residence K Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __/--.- Number of bedrooms ... --- Number of baths __-_-_ Lot size __ 10__10...k___/_0..6---_---_--__-___-_---_ Water Supply: Public system It Community system ❑ Private Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam..K Clay Loam [❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: YesNA No ❑ New Construction: Yesg No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank-or cesspool permitted if public sewer is available within 200 feet.) j Septic Tank: Distance from nearest well_-. -L).__/__Distance from i1Qundafion__ ____._____.Material-_ ------ ---- _.,----._�... No. of compartments...........comP --- ._Size-_-- _ Li uid Capacity,/ ��r �-� G depth.____�---..---._-_- Disposal Field: Distance from nearest -------Distance from foundationol:o____-------Distance to nearest lot line- Length ine_ i of lines--------- .._ Len th of each line------ __ ro -. _ 'Width of trench----- __ --------------------- Number- gU' Type of filter material-__- __ Depth of filter material---- .__.. Total length____�___Q--------------- Seepage =:.___.___. - ' See a e Pit: Distance to nearest well_________ ___ Distance fr fou dation______ -_-.Distance to nearest lot lines _ j_`• p g f _ Number of pits----- ming material �f Size: Diameter---- f p � + Cesspool: Distance from nearest well____------- -_--Distance from foundation 6--- ..Lining material_________----------------------------- 1:4 ❑ Size: Diameter. - ----. -- -Depfh ---------------------- ---- ---------Liquid Capacit -------------- _--------_gals. �r.ir'.:`rr�iri�,w��w�iCa�wr�J"^–.�••s-�'tea^^-"'r=±.�,x–«-�' Priv Distance from nearest well-------------- .Distance from nearest buTdin --- ❑ Distance to nearest lot line------------ -------------- ---------------------------------------------------------------------------------- - R e Remodeling and/or repairing (describe):--------_----------------------_--------------- ---•-••:---------------------------------------------------------------------------- --------------------------------------------------------------------------------- --------------------------------------------------- " i ------------------------------------------------------------------------------------------------------------------- ----------------------------------------- } ----------------------------------------------------------r___.-..__.----------------------------------------------------------------------------------------- f 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, w . .___. Owner and/or Contractor � {Signed}-----....-- ---•-- -------------------- --------------------------------- ----------------------------•---' - ----------------------------- { � ) B ' • -------------(Tifle)-------------------- Y• ••. ----_--- (Plot plan,.s owing size of lot, locafion of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ? APPLICATION ACCEPTED BY -- ---- - --- --- DATE - REVIEWEDBY--------------------------------- ----- -- - -- ---- ---------------------------------------------------- DATE------- ``-- BUILDING PERMIT ISSUED------------- - ---- - DATE ------------ `'s.. ..... -_ - �` erations and/or recd mendatian Y - -- ------------ ---------`---------------- -------------------------------- ----------- ------------------- . ------ .a r7 ---- -------------- --- - FINAL INSPECTION BY: / -== Date..... V� --------- ----�- �5 SAN JOA UIN LOCAL HEALTH DISTRICT 130 South American StraO 300 West Oak Street132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9' 145445 ATWQUd �• '