11902 - Laserfiche WebLink

Home Browse Search

i -lop APPLICATION FOR -SANITATION PERMIT Permit No. (Complete ;n Duplicate) This Permit Expires 1 Year From Date Issued Date Issueed --- ------- Application is hereby made to the San Joaquiri 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 LO TION Owner's Name___-__W-it- ----------- - - ------- phone------------------------------------ ------------------------------------------------------------------------------- Address... ------- ------- ---------------m �l-------1�--------------lea----------------i--------------------------- ------------ - - -- ------___------__-.._d,__- Contractor's Name----------- ------ -- ---. "I'� -L� (14--e Phone- ------------...... ------ --- ---- --------------e, 40;-�-- _......�,C4.....W. ............ 'MI Installation will serve: Residence ER, Apartment House El Commercial [-] Trailer Court Ej Motel [] Other ❑ Number of living units: Number of bedrooms 3---- Number of baths --2--- Lot size -----4-k�- ____________________________ Water Supply: Public system [AlCommunify system F] Private' E] Depth to Water Table 10-- ft. Character of soil to a depth of 3 feet: Sand [] Gravel [:] Sandy,Loam E] Clay Loom [D Clay E] AdobeT Hardpan C] Previous Application Made: Yes L] No 2�,�Iew 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.) Septic Tank: Distance from nearest well_______________-Distance from foundation_________________.-Material------------------------------------------------- 0 No. of compartments--------------------- ----Size---------------------------------Liquid depth---------------------------Capacity,.-.------------------- Disposal apacity---------------------- Disposal Field: Distance from nearest well____"''.__.__._Distance from'foundation-A0------------Distance to nearest lot line---if------------ Number of iines------------I--------------------Length of each line------------------------------Width of french------Ze-*----r------------- Type of filter maferiaI---WQ-6-*\------Depth of filter material----lk-'I'----------Total length--------1-0-------------------------- Seepage Pit.- Distance to nearest well------—"_____.____Distance from foundafion-,/O-------------Distance to nearest lot " Number of pits.__._____._____-----Lining material------T-0- -?C ----Size: Diameter--- k 7,A-6 ----------Depth- ------- Cesspool: Distance from nearest well-----------z-----Distance from foundation--------------------Lining material__-_._.__.______________._______--_-. ❑ aterial---- ------------------------------ El Size: Diameter-----------------------------------Depfh---:----------------------------------------------Liquid Capacity---------------------------gals. Privy-. Distance from nearest well-------------------------------------------------Disfance from nearest building______-__.__________________.___..___.._ ❑ u;1ding--------------------------------- ------ F-1 Distance to nearest lot line--------- ------------------------------------------------------------------------------------------------- ---------------- Remodeling and/or repairing Idescribe):---------!--------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------ --------------------------------------------------------------------------------1-----------------------------------------------------------------------------------------------:-------------------------------------------- -------- -------------- ------ ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sfaf7el s. and rule j; and regulations of the San Joaquin Local Health District. (Signed) ------------ ----------------------------------------------------------------------------------------------------- --------(Owner and/or Contractor) By:-------------------------------------------------------------------------- ---------------------------------------------------------(Title)--------------------------------------,-.................... (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-,R.-P---------------- ------- ---------------------------------------- DATE-------/I/- REVIEWEDBY-------•--------------------------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED----- ----------------------------------------------------------------------------------------------- DATE------ ------------------------------- Alterations ATE--------------------------------------Alterations and/or recommendations:__-----.4....... ------- ------ ---- --. - .--. (I C-----------------------------------------------------11--------- K - -----—------------- - -------- ------------ --------•-•--------•----------------•---- ------------------------tv ------------------------------------------------------------------------------ ---------------------------------------------------------------------------------------------------------------------------------------------- --------------------- ------------------ --- ------------------------------------------------------------- -- ---- ---------------------------------------------------------------------------------------------------------- ------------------------------ ----- - - - ------ --- ----- -------- -- ----- - ------ ---------- - -------------------------------------------------------------------------- -------------- ----------------- FINAL INSPECTION BY:- --------- - - - ------ --- - -- ---- ---- ------ --- Date-------- -- f &. 4------------------------------------------------- ------ --------- 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 FS-9-2m Rev'sed B-'59 FYCo-