10002 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATIQ I KR1v�IT Permit No. __l a_o.o__. /4 (Complete in Duplicate) EXPIRES ONE YEAR --------------------- 14 LJ � p p I Datl Issued ___ J: .OPrI DATE T I Application is hereby made to the San Joaquin Local Health District for a pdt?fftV1=tTtt m1Ttrt-errd��ork herein describe This application is made in compliance with County Ordinance No. 549. E �o /,f y,. 1 `_ - JOB ADDRESS AND LOCATION ------ ---?� -------------- �,�----------•----- -- •�,�---:----- Owner's Name---lT• ---- ^- �►---- ------------------ -----------••-• ------ Phon -------1. 47_�� ------------------------- Address--------- ,a _• Contractor's Name --------------------------------------------------------------------------------------------------------------- Phone----------------------------------- Installation will serve: Residence W Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: j____ Number of bedrooms Z___ Number of baths -1----- Lot size ---7474.-_-yr.,3----------------------------- Water Supply: Public system ❑ Community system ❑ Private 0 Depth to Water Table --Tr ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam X Clay ❑ Adobe ❑ Hardpan I Previous Application Made: Yes [❑ No 0 New Construction: Yes ;C No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet-L., Septic Tank: Distance from nearest weIL--`-6-0------Dista ce from foundation-- 00----------- Material------------------------------------------------- KNo. of compartments----—---------------Size_ 3 .- ---.---:_--Liquid depth--- ��----------------Capacity--R' _.......... Disposal Field: Distance from nearest well.._4 4r,-----Distance from foundation__ ?-----------Distance to nearest lot line__.^....... Number of lines____---------_ Length of each line---6_�1_'_____._________-Width of trench___A Y-_`_'___________--------- Type of filter mate ria 1174 p! �Depfh of filter material---/__PS---------Total length______60------------------------------ __ ___ _ Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line____.-____.____._ ❑ Number of pits----------------------Lining material-------------------.__-Size: Diameter-----------------------Deptn.-------------------------------_-- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material--------.---------.----__-_______.___. A ❑ Size: Diameter------------------------•------------.Depth----------------------------------------------------Liquid Capacity_--------------------------gals. a1 Privy: Distance from nearest well-------------------------------------------------Distance from nearest building--------__._______________________-__. ' i ❑ Distance to nearest lot 6e---------------------------------------------------------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe):----------------------------------------------------------------------------------------------------------------------------------------------------------V ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- .- -------------------------- -----------------------------------------------------------------------------------------------------------•------------------------------------------------------------------------------------------------------------------ ! hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances"I ,/arule, d regulations of the San Joaquin Lacel Health District. "(Signed)---- ------------------------------------------------------(Owner and/or Contractor) -By:------- - - -- - ---------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on-reverse side). -FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- ----------------------------------------------------------- `7 ---------------------------- REVIEWEDBY-------------------------------- ----------------------------------------------------------------------------------------- DATE-------------------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------------------------------------------- Alterations and/or recommendations-------------------------- ---------------------------------------------------------------------- ------------------------------------ ---------•-------•----------------------- ------- - = '� ------ ------------------------------------------------------=-------------------------------- -------- ------------------------------------------------------ ---------------------------------------------------------------- i FINAL INSPECTION BY-------- ------------------------------------------------------- Date-------------------------------------------------------------------- - -- 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 F.P.CO. i I