9152 - Laserfiche WebLink

Home Browse Search

C APPLI - CATION FOR SANITATION PERMIT Permit No. ._.-5'�J__1_ (Complete in Duplicate) / l Date Issued CVs.-7--- Applica+ion is hereby ma e to the SaJk2� Iuin Local Health District for aermit to con r This application is made in compliance with County Ordinance No. 549. p st uct and install the work herein described. JOB ADDRESS AND LOCATION-------G'u_-4/- 7 S). .`I ,. --------------------------------------- ---- Owner's Name --- - - v-- --------------------------------------------------------------- ------------ --------------- ----- Phonej ---- Address------------------------------- ----------------------------------- - --- - Contractor's Name--------- _`__. ----- /� -----------------------------� - --- --------------------------- ------------- Phone.10 -7/ - Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ (fMotel Other [�] Number of living units: ___1___ Number of bedrooms ."F- Number of baths __.._�_ Lot size .._ (.�'� 3a-0 �- ---------------------------------------------- Water Supply: Public system ❑ Community system ❑ Private R-15epth 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 [ 'New Construction: Yes D_-No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ,Septic Ta Distance from nearest well-_;______________Distance from foundation--------------------Material _____..___..____.._._...__...____..___-._____. No. of compartments----------- ------------Size--•------------•----------------Liquid depth----- -- ---- --------------Capacity----------------------- Disposal F' Id: Distance from nearest well_-______.___._Distance from foundation----------------____Distance to nearest lot line-_-.._-_---______ Number of lines----------------------------------Length of each line-------------------- ---------Width of trench Type of filter material---____________________Depth of filter material----------------------- length___---_-_-_-.-.-._-_ Seepage Pit: Distance to nearest well �_�'0__-+ _Distance from foundation-___..__ _ Distance to nearest lot line_, Humber of Pits-----f______-__.__.Lining material----P''- i/___-Size: Diam er-_____3V____-_-Depth_____.-_-----_---.--•-__ Cesspool: Distance from nearest well-------------- from foundation------ ------ Lining material-------- ----------_----------------- 171 r Depth---------- ---------------- - ------- --------Liquid Capacity--------------------- Privy: Distance DI stanDce Diameter ------------gals. Priv from' nearest well.___________________________------- - Distance from nearest building❑ Distance to nearest lot line_-____.-._.. _ V Remodeling and/or repairing (describe):_-__�A=�± _ ��... ~ .�-- =------------- A------------------------------------------------------------------------------------•-------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County --------------------------- ordinan tate laws, and rules and regulations of the San Joaquin Local Health District. (Sig end) ---- ------ ----------------------- ---- ------ ---- -Owner and/or Contractor) BY:..........-•---•-• ---•---• / ---------------- ----------------------------------------------(Title)-_ ° (Plot plan, showing size of lot ocation of system in relation to wells, buildings, etc., can be placed on reverse, 1 A FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-----_.-_ -----.-----------_ .-✓--,--------------------------------------------------------- DATE --------------- --------REVIEWED BY ---------------------- - - ---"----------------------- DATE BUILDING PERMIT ISSUED-------- - f ------- -- ----- - - DATE----------- --------------------------------•----------------- • -- --- --•---------------------------- aerations and/or recommendations:_.______.__ ----- -------- --- ----- --- - ---------------------------------------------- -------r ,, -c ------ - --- ----- --• _ _ _ ��=--: - -_ - :_ ----------------- ----- ----- ------------- 4 FINAL INSPECTION Date---_4f V SAN JOAQUIN LOCAL IEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Traey, California ES-9 145446 ATWDDD