10167 - Laserfiche WebLink

Home Browse Search

APPLICATION FG- _ SANITATION HERMIT Permit No. (Comp[efe in Duplicate) /o S " 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 OrMnancffe..NNo�o. 549. JOB ADDRESS le AND ; ATION. _ ,( , s ___----- ---- ------ P ---------------------------- - Owner's Na __ - E --•----•------------------- ---------------------- ----------- -------- Phone.�_wl-4.3 Z0--- Addressf ---- ------------ - ----------------•----------------------- Contractor's Na a----- �� -=------ -------------------------------------•------ Phon, � ti Installation willserve: sidence partment House ❑ CommercialxE] rai[er.Cour#-[D.fMotel ❑ Other ❑ Number of livin 6nits: _�_�,,,,,�.u,�n.jp r of bed_r-ooms _:..I_ Number of baths __ _ Lot size __- _0-d_-V--------------------------------- g�� i i fl Water Supply: Public system Community s m ❑ Private ❑ Depth foi`ater Table _-Y4 ft. Character of sod to a depth of 3 feet: Sand ❑ G re el❑ Sandy Lo"m ❑�C14toarn ❑ Clay ❑ Adobe �ardpan ❑ Previous Application Made: Yes ❑ No �ew Con�strOetion: Yes h--<, ❑ FHA/VA: Yes ❑ o ❑ TYPE OF INSTALLATION AND SPEC IFICATION}S: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic Tek: I Distance from, nearest well? stance from foundation_-- _____.Mate�ial-_�__t_____r__ _ - --------- EWO No- of compartments__-___pL-_ ____-_.__Size__ -� -____Liquid depth_-__ __,l Capacity---- Disposal 'eld: Distance frominearest- well is#ance from foundation__/_&_f__ Distance to nearest lot `ine_________ �1 Number of lines____________-__ ___ ___Length of each rline_____��__-__________ Width of trench /_ ------------------ fi � ----------------- Type of filter materials 7 Q _ _ __ Depth of filter material_-_______.__.Total length________________ _ f _ S �-�,� r Seepage Dis#ante fo nearest welly _ _____Distance m feundation__ �1__........Dista��e to nearest lot line__0 Number of pits_____/_____________Lining material--*___-Size: Diameter--_s __. -----Depth _________________ Cesspool: Distance from est well_____ ,7"'__-Distance from foundation-------------------Lining•:Material_---_--------__-_________-____-------S El Size:'Diameter-------1------------------- ---De th---_------------------------------------------------Li did Capacity gals. Privy: Distance7from nearest well ... _____________________________Distance from nearest building _______`-_,_______________. ❑ Distance fo nearest lot line - - — ---------_ ----------------� ------------ --- i t ------------------- 1 " Remodeling and/or rep'a16ng (describ )•----------------- ---------- ----- ------------------- ! . -------------------•- j------------------------------ ----•-- -------- ------------------ ---------••-------------------------------------- ------------------------------------ --------------------------------------------_-••----_--...,-.._g_,. ... __.. -----.�.__��.: I hereby if that I h e pr pared this application and that the work will be done in accordance with San Joaquin County ordinances, S ws, d u! s d regulations of the S Joaquin Local Health District. (Signed)----..... .... - Q ----------- ----------------------------- caner and/or Contractor . By:--------------------------------------•--- - ----- - -------------(Title)- f -- --------------- (Plot plan, showing size of [ot, locatio of system in relation to we ildings, etc., can be placed on reverse side]. FORS DEPARTMENT USE ONLY] APPLICATION ACCEPTED BY - � DATE _ REVUE E PERMIT ISSUED ----- �'--------------------- --- --- ------------ DATE_;.- -• -----------"----------------------------- DATE------��------------------------------------------------- M� Alterationsand/or recommendations:------------- ------ -------,_,__-,_.-.--�------------------ � -- ---------•-----------------___--•--------•-•------------------------- ----------I----------------------•----------- ----------------_ --------.....................------------------------------------------------------------------------------------------------------------------ ----•--- ----•----------------•----•----•--•--------------- ----- -------------------------------------------------------------------------------- ------•-----------------------------------------------------------------------. FINAL INSPECTION- BY:--�-it----�--------------- - -------------------- .. Date----��_�__L'-�_� �-------------------------------------------- 1 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 E5-9-2M Revised 1-57 F-P.GO-