8743 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. --C� �`-��----- I {Complete in Duplicate) Date Issued A plication is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This applicatiori is made in compliance with County Ordin ce No. 549. JOB ADDRESS AND LOCATION_ -- ---------- - - ----------------------------------------- - - ------------ Owners ame_____ klf 0 ZZ Phone Address.---- - *"t—&�_-------- - -------- ---- --Contractor's Name_____________ ----- ----- i --- Phone.. Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court El Motel ❑ Other ❑ o Number of living units: _j____ Number of bedrooms __R--- _ Number of baths __ _-- Lot size ___ .- . Water Supply: 'Public system Community system El Private ❑ Depth to Water Table`�ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy-Loam F1 Clay Loam El Clay ❑ Adobe Hardpan ❑ I Previous Application Made: Yes ❑ No r-1NewConstruction: Yes El No ❑ FHA/VA: Yes E] No ❑ [No septic ONS: tic tank or'cesspool permitted if public sewer isLi available within 200 feet.) TYPE OF INSTALLATION AND SPECIFICATIONS: /� Septic Tank: Distance from nearest weal Distance from !ff/ooundation__`V____ ___-�M/aur'sal__[s6----------------------------------- Size_ ' _ _T__ ----Liquid depth--_-V_k----- ---------Capacity---, • ---- ®/" No. of compartments___-.------------------ .. � X � _______-.Distance to nearest lot`ife_--�__--_-_.- Disposal Field: Distance from nearest well-!± "-'--Distance from foundation__ _� Width of trench__ f�f Number of lines______- Length of each line-_�i.�-- --- -------- �1- - -_____ Type of filter material �-_4 Depth of filter material__1 -Zo---"--.---Total length____.( "--------------- qq � _Distance to nearest lot line_ _____-_-- Seepage Pit: Distance to nearest weli___. T �Distance from fou ation_.�5. _.___ �� Depth___"_ ®-�------•------- ke Number of pits_-___ _ ____"_- -______Lining material_/_p_Ae-0_ -Size: Diameter_ __ ________- - Cesspool: Distance from nearest well-----------------Distance from foundation-------------------_Lining material-_-_.______-_.___-______--_________. Depth ------------------------------------------Li Liquid Capacity gals. � ❑ Size: Diameter--------------------------------- - p q p Y----- -----------------.. Privy: Distance from nearest well________________________ -----------------------Distance from nearest building------.----------------------------------- r -------------------------------- Distance to nearest lot ine__-__.--------------- -----•=--- ---------------- i / ---------------------------------------------- Remodeling and/or repairing (describe):_,__--- i ----------------•--------- - ----------------------------------------------------------------------------- ' 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. 5s ned '�.�� - ---[ r) By-----•--------------------- - -- -- ------- " [Title- Plot Ian, showing size of lot, loco;: of system in relation to wells, buildings, etc., can be p acl ed on re side). { P FOR DEPARTMENT USE ONLY -- DATE------ APPLICATION ACCEPTED BY----------- ---------- ----- --------------------------------------------- -- - - -- ----- DATE------------ --- ------------------------------------- REVIEWEDBY---------=----F- ----- ------------------- --------- -------------------------- ----------------- BUILDINGPERMIT ISSUED---•-------------------------- ------------------------------ and/or recommendations--------------------- -- ----------------------•-------------------- --------------------- --• %%--- ------- -------- --- - --- ------------j____ ------ ------- ----------- -------- a -- ------------------------------------------------------- -------------- f .40 / = = = = Date" (-------•-------------_----- FINAL INSPECTION BY:--------- -- ---- ------------ SAN JOAQUIN LOCAL HEALTH DISTRICT j132 Sycamore Street 814 North "C" Street 130 South American Street 300 West Oak Street Y Tracy. California Stockton, California Lodi, California Manteca, California y� ES-9-2M Raviseci 1-57 P,P.CO.