10354 - Laserfiche WebLink

Home Browse Search

�\ J APPLICATION FOR SANITATION PERMIT r.M )4 3---' [Complete in Duplicate] �Z /S Date Issued Applica#ion is hereby made to the San Joaquin Laca Health l]istrict #or a permit to cons#r and�� a41#fie work herein described. This application is made incompliance with County Ordinan Fe4Not49. ► '* °`� '' �° �, r -----------�---------- JOB ADDRESS AND CATION.. --- --. .. - ------ Owner's Name-------- •<l /f.� ----------- ------�--------. Phone----•--------------•-------•----•--- _v-_ __1i l. �s' ----------- - ------------------•----- Address------------- - 11- - --- -- - ------ -- ---�----• --- -- - ------------------------------- f� -Contractor's Name-------------------- --- --- ----------------- ------- ------ Phon . _.- -_-f .a - Installation'will serve: Residence 'Apartment House ❑ Commercial ❑kTrailer Court ❑ Motel ❑ Other [I,�/ Number of living units: __/_ Number of bedrooms g?-. L__ -. Number of baths ___,Lot size ----?__ Water Supply: Public system ElCommunity system Private❑ Depth to Water Tab e'�___ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe R-_-Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes W?"No ❑ FHA/VA: Yes 5�---`No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (Na septic tank or'cesspool permitted i publi s er is available within 200 feet. _ /,//�� )s G Distance from fou dation- -- -.Material-l,�- Septic nk: Distance from nearest we ______ t K K, ----:_.-Liquid depth--- l"Z----------Capacity--- gill No. of compartments--- ° Size.-,I;;_ _ __ _ ____ Disposal Field: Distance from nearest well/!A-_.__.-.- _Distance from foundatio i -----Distance to nearest lot line_________________ Number of lines.______-_R- -- ---------- -Length of each line-_�. .___- _____.Width of trench_____a� -�f_______________ Type of filter material__sr:��/,,-- - _ '._Depth of filter matenal____ X.___.......Total length-__-__-. ____; ___________________ seepage Pit: Distance to nearest wel?1 4_______. . __Distance from foun ation__ ....._......Distance to nearest lot line________________ Number of pits.�_�---------Lining materiel_ Size: Diameter____. .a._ ____.Depth a Cesspool: Distance from nearest well-----------------Distance from foundation_____---------.-----Lining material-_-.------------_-______------_---_. ❑ Size: Diameter---------------------------------------Depth-------- --------------------- ---------------------Liqui.d Capacity----------------------------gals. Privy: Distance from nearest v✓eIL________ --- .._"_'---------------------Distance-from nearest building---__.______._______________------------- ❑ Distance to nearest lot line-------- ---------------------------------------l ! w ----------------------------------------------------- -- Remodeling and/or repairing (describe):------ ----------------------------------------------------------------------------- � ------ I 1 •----------------------------------------------------------------------------- _________ _ ----------------------------------------------------------I------------------------------------------------------------------ I hereby ce 'fy that I have prepared this application and that'the work will be done in accordance with San Joaquin County ordinances, St e I ws, a rules regulation of the San J quip Local Health District. (Signed} � ----------- --------------------- (Owner and/or Contractor) or) -•--- - ti --------------------------------------------- By-------------------- -------------------- ------------ - --- - ---- ----- - ------------------------(Title ) [Plot plan, showing size of lot, location of system in relation to Is, buildings, etc., can be placed on reverse side]. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- DATE = ---------------------------------------------------- ---- ------- ------------------------------------------------------------------------------- REVIEWED 13Y , DATE-_�---------------------------------------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE----- .----------------------------------------------- Alterations and/or reco mendations: ----------------- --- ----- --------------------------------------------------------------�=------- ------•------------------------------- ----------- J----�--- - - �------ ----- - s sl------- -----(I-1 l --------------------------------- -- ----------------------------------------------- ------------------- - A..----F� __: . - w ---- _ ------------- -------------- ------------------------------- ------------------------ ---------- FINAL INSPECTION BY------ --------------- --- -------- f' Date= j /y/ -- C010Q-- 6!" lk"� SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South erioen Streat 30D West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 1-57 F.P.CO.