11328 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) _ Date Issued ___------ Application is hereby made to the San Joaquin 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 ANDLOCATION_ ' . fav i -. = 3 -- -- ---- --- Owner's Name _ ------------------ Phone----------------- Address----_--------------- r 1E, L' a ........... Contractor's °Name Ar'^,R'`' ------------ ---- - ---- -- •-- ----- Phone- 4 , Installation will serve: Residence-E] Apartment House ❑ Commercial ❑ Trailer Court ❑ ' Motel • ❑. Other � < = Number of living units: --`_ Number of bedrooms -------- Number of baths -------- Lot size ___7-19,_ i. --------------------------- --- Water Supply: Public system ❑ Community system ❑ Private X Depth fo Water Table ___=___ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam R- Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes [:1 No ❑ New Construction: Yes E] No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Distance from nearest well_- !__"--�-•Di p w61_5!0_---- stance from�foun�aation__ _U_____ __..Material____C -C_�_----- . - ++� ------ ' -------Ca acit __1,2 a-- --- Se tic Tank. No. of compartrnents_____2�_--- n Size�1_..k--`t� A�'_:`�•_- Liquid depth_____,._______.-__- p y Disposal Field: Distance from nearest w'ell----"---------Distance from foundation_-____--___--___-_.Distance to nearest lot lire_________________ f�J Number of lines-----------Q"+�t— ----- --Length of each line------�V---------------Width of french-__��----••----:---------- �. Type of filter material_ t_ !"_Depth of filter material-----,_��-__-----Total length______--------- ►� Seepage Pit: Distance to-nearest well---/ e________Distance f m fgundation----_................Distance to nearest lot'liqe----------------- 9 Number of pits____- ____Lining maferial__ C p z---Size: Diameter__-41�A"_ ----- -.Depth----1 -------------- -----•- Cesspool: Distance from nearest well_________________Distance from foundation ------------------ Lining material________-.._____:_-______._-__ ❑ Size: Diameter-------:--------------- -------------Depth---------------------------------------------------Liquid Capacify-------------------------.-gals. Privy: Distance from nearest well-----------------------------------------._..---Distance from nearest building--------__ ❑ - Distance to nearest lot Sine------------------ = - 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 la s, and rules and regulations of the San Joaquin Local Health District. a-Z (Signed)-------- •--------------- - - --•--- -- -------------- ------ ------- -------• -- -------(Owner and/or Contractor} By=----------------------- -••--------------------------------------------- ----- ------------ Tale - ------------------- (Plot plan, showing size of lot, location-of-system in relation to wells, buildings, etc., can be,placed on reverse side). ORS TME T USE O LY S APPLICATION ACCEPTED BY----- - -- ---------- '' - " = --------- --- DATE _. REVIEWEDBY ----------------------------------------------------- ------ DATE ' BUIL DIN PERMIT ISSUED --------------------------------------------- ----------._. DATE. Alterations and/or recommendations:--------------------------------------------- - - Q kei---�" �` �' ----- ------------------------------ --- r� J' ------------------------------------------------ ` FINAL INSPECTION Date------1 F/ -------- - 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.