2773 - Laserfiche WebLink

Home Browse Search

i APPLICATION AOR SANITATION PERMIT Permit CliDuplicate)(Complete n upcae) pate 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. I JOB ADDRESS AND LOCA ]ON----------- - �- ------: -- � ----------- ---- - - '----- -- -------------------------------- - i Phone Owner's Name--------- --------------- ----- 'f" u�' _ --- Address-------------------- ---------- --- -------- ------ ---- ,1 Contractor's Name-------- _ -_�___-_d-- ��_ Phone 1 � � # Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units:Ail? Number of bedrooms-__ Number of baths -/-__ Lot size _ XJ2 U - Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table,-5�� ft. ` Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe �ardpan ❑ Previous Application Made: Yes ❑ No 4----New Construction: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) __.Ma ri I-- -f- -------------- Septi - � c T nk: ,- Distance from nearesr well ,-��__-_-Distance f om foundation_ ®--_____ f� - - �' yy y p r �I ..,Liquid.de. t , `' Capacity No. of com artments _` __Siie--_r_ Ga acitd____--___ � 'r Disposal Field: Distance from nearest ell_ a Distance from foundati �� Distance to nearest lotline-L .---- Number of lines___ -_- of each line Q-- d-:--_.Width of trench-�� _ pyff ---------------- Length E Type of filter materia ®4._ Depth of filter material--/_�_------- Total len gth---Z------------------____------_.-- Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line-_----____---._-_ > ❑ Number of pits----------------------Lining material-----------------------Size: Diameter---------------------- Depth-----------------_--------------- • Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining Material___--------.____-_--_----__-----_---_. ❑ Size: Diameter----- --------------------------------Depth----------------------------------------------------Liquid Capacity---------------------------gals. . . _ _� --- Privy:' Distance from nearest well_ ____� -_-__-_:- _"-" '" _ _:-Distance-from nearest building_ �:�--------------____-_ ❑ Distance to nearest lot line---------------------------------------- -----------------------------------------------------------------------------•----------------------- Remodelinand/or repairing describe -------------------------------------------------------------------------------------------------------------------------------------------- -------•---------------------------------------------------------------------•------------------------------•------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•-------- --------------------------------------- ----------------------------------- ----------------------------------------------------------------------------------------------------------------,----------------------- 1 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 +he San Joaquin Local Health District. (Signed)---------- r 04 %--- -- ----= --- . e ---------- ---- -----------------------------------(O er an or Contractor. BY: SFr --- ---------------------------------------------------------- ----(Title (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). x x FOR DEPARTMENT USE ONLY -' ------------- DATE----------------------- APPLICATION ACCEPTED BY------------------- -- -- - -r REVIEWED BY -------------- --- DATE BUILDINGPERMIT ISSUED----------------------- ----- ------------------------------------------------------------------- DATE `� Alterations and/or recommendations-------------------------------------- ------------------------------------------- ------------------------------------------- -----=------- ------------------------------------------------ ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------- i ------------------------------------------------- FINAL INSPECTION BY:------------ -----IA(A�r --- Dateb ---------------- - -- ------------ -------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street t Stockton, California Lodi, California Manteca, California Tracy, California 1 �F - ES-9-2M 8-51 Revised W-2100 I. —-- --