11715 - Laserfiche WebLink

Metadata

Thumbnails

Annotations

i ti l/ / APPLICATION FOR SANITATION PERMIT Permit No. ._�l.�l..J----. (Complete in Duplicate) � Date Issued ' This Permit Expires 1 Year-From Date Issued 1 Application is hereby made to the San Joaquin Local Health District for a permit to construct and in all the work herein described. This.application is made in compliance with County Ordinance No. 549. JOB ADDRESS; AND LOCATION _ _. !� _. ------------------------------------ Owner's Name ------��' �3- _ �- U' -f-------------------- ------- ------------ ----- --v--------- -------------•--- ---- -- Phone--------------------- i : ---------•---- D' : aAddress --------------------------------------------•--------------------------------------------------------------------------------------•---•----------------------------------- Contractor s Name " ;►--- �!`"V14 -------------------------------------------- Phone .. Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --- Number of bedrooms ---- -_ Number of baths -----I: Lot size -----7-6_ h --,136------------------------------- Water Supply: Public system ❑ Community system E Private ❑ Depth to Water Table _: ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[' Hardpan ❑ Previous Application Made: Yes ❑ No E New Construction: Yes W No ❑ FHA/VA: Yes Ej 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--_. . q -- -------------Size..... -` '--- "�`----'�'-' ---Li Liquid depth------ --Capacity-109------------ Disposal Field: Distance from nearest well------XX.....Distance from foundation----14'.___...Distance to nearest lot line____ �__---._ Number of lines_ .�._ ____ ---Length of each line__ 4 ____ .Width of trench 2-4-t-___ - Type of filter material__ 0.4- ------Depth of filter material __ -----Total length-__ _----------------_ Seepage Pit: Distance to nearest well-----X°x---._-_____Distance from-foundation--- 0 '__.Distance to nearest lot line ' Number of pits-_-----2--------------Lining material- -..-__.-..Size: Diameter_-- ------------Depth __ _' :--____-_ Cesspool: Distance from nearest.welL_____-----------Distance from foundation---------------------Lining material-_____________________-________-- .r„) ❑ Size: Diameter-----------------------------------=-Depth..------------------------------------------------Liquid' Capacity--------------------------gals. Ulj Privy: Distance from nearest well------------------_------------------------------Distance from nearest building________.___.______---_--____-_-___------. (� ❑ Distance to nearest lot line----------------------------------------------------------------------------------------------------------------------------------------------- i Remodeling and/or repairing (describe):------------------------- -W- s 4 t a -- --•-------•-------- - - ------ -------------------------- - - 1 ---- ------•------------------------------- --------------•----------------• ----- -- --- ---- ---- -- -------- -------- -------- ------ -- -------------------------------------------------- --- 1 ------------------------------------ ---------------------------------------------•------•----------------------••-----------•-----------------------------•---------------------------••----------------------------- 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. (Signed) +0 '•-AV- -- ------- ---- - ----- --------(Owner and/or Contractor) By:------------------------------------------------------- (Title) - - - (Plot plan, showing size of lot, location of sys+ n rel,+ion to wells, buildings, etc., can be placed on reverse side). 1 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------- -- --------------------------------------------------------- DATE--------- "L ' a--------------------------- REVIEWEDBY------ ----------------------------------- ---•- -------------------------------------------------------------------------- DATE---------------------------------------------------------- ` BUILDING PERMIT ISSUED----------------------- --------------------------------------—------------------------------------- DATE------------------------------------------------------------ Alterations and/or recommendations:----•---- �---= ---- --------------------------- -- .------------------- -- -----••--•-------------------_------ f ------- -• -- ---- } } -•------------------------------------- -------------- ---------------------- -------- --- - - FINAL INSPECTION BY:- - - - Date ` ------------ SAN JOAQUIN LOCAL HEALTH DISTRICT w 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street x] ` Stockton, California,.,_ Lodi, California Manteca, California Tracy, California 2 _ i ES-9-2M Revised 8-'597F: - i