10710 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. _ �t._Z .. (Complete in Duplicate) Date Issued --- Application is hereby made to the San yJoaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. , : JOB ADDRESS AND LOCATION_____�e -_[------- 11 Owner's Name_ =" � i fir----------------- ------- ------------ ------ T Phone Address------------------------------------------ Contractor's Name----------------------- - -----------------------------------,--------------------------------- Phone - Installation will serve: Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -_7.i Number of bedrooms ;�t__._ Number of baths _Z_ Lot size `----------- •----------•-- Water Supply: PublicsystemE] Community syste El Private [Depth to Wafter Table 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 ❑ No ❑ FHA/VA: Yes ❑ No ❑ , TYPE OF INSTALLATION AND SPECIFICATIONS: _ . -.._ is �1—permitted i# public sewer is available within 200 feet.) (No septic tank.ar`cess oo I r � p Septic T nk: Distance from:nearest well__i�_ ---Distance from foundationJO!' "'.Material- �__. . _ _ . __:_-____ .._... �'�' �'-�-�.___Liquid depth____ ___�___ --------- Cepacity_1Q - No"of compartments_--��-'-------------tSize._�_.--___-- -- r �. � - t r � r Disposal Field: Distance from nearest well��_'� 'Distance-from foundation__/�--r►ti--Distance to nearest lot Number of lines_______' -- -- __ Length of each•lire-----6__P------------ Width ofgtrench-..�--r�_ -`-_.__ ------------- T e of filter`matenal____�_ __. ---- _Depth of filter meter`al-___�2_ -----------Tota! Oen th----- Ie______________ YP Seepage Pit: Distance to 'nearest well----------------------Distance from foundation--------------------Distance to nearest of -- 171 Number of pits---------------------Lining material--------------f----- Size: Diameter----------------------Depth------------------ q f Lining material_____________- ___ N Cesspool: Distance from nearest well-----------------Distance from foundation----------------- , ___-_______.___. Size: Diameter------------------ ---_---------------.-Depth------ `-------------------------------------------Liquid Capacity--------•-------- gals. ❑ J, -� Distance from nearest buildin ` Privy: Distance from nearest well------------------------------------- ----- g - - s H . ' Distance-fio nearest lot line------------- -----------= --------- - -- -----------------------•-----------=-------------------------------------------- ------------- Remodeling -----------Remodeling and/or repairing (describe):---------------------------•------------------------------I------------------------------------- --- ------.-----------------------------.-------- i ------------------------------- ------------------------------------------- --------------- ------- ------------------------- ---- --------------------------------------- ------------- ------------------------------------------------------------------------------------ I hereby certify that l have prepared this application and that the work will be done in accordance with San Joaquin .ounty ordinances, State law ,!and les and regulations of the San Joaquin Local Health District. (Signed)__ _ --�-- ---'C-� ------------------------ 1 caner and/or Contract (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). F PA NT U ONLY DATE----4> -- ~ "� APPLICATION ACCEPTED BY--= - -- REVIEWED BY------------- ---- DATE = = = BUILDING PERMIT ISSUED--------'------------------ -------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations:---------------------------------- ------------------------------•--------------•--------------- ------------ --•-•------------•--------------------- -------------------•-••---------------------------------------------•---------------- ---------------------------------------------------.......--------:------------------------------------------- ---------- -------------------------------------------- ------- t '-------------------------------------- ------- --------------------w--------I------- ------------- --- -------------------=--•- ------------ •------------------------------- FINAL INSPECTION BY:------: '411,-------- ---------- ----------------------------- _4 Date G I 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 A ES-4-2M Revised 1.57 F-P.Co_