10206 (12) - Laserfiche WebLink

Home Browse Search

b - pY .,V4 / APPLICATION Y FOR" SANITATION PERMIT_ Permit 9'" (Complete in. Duplicate) 31 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. f/�I� L/�Z5 y� 3S X704/ 1/70.5" 1117 it/ y.7� c .3 B ADDRESS AND LOCATION-_'96 -- - ----------yt OwnersName-----------------------�- -�--- - - ----------------------- -------- - ----------------------------------------- Phone--- ----- Address--------------k -----------------2--�--1------W-------q--------'--------- -------- ---------------------------------------------------------------------------•------------------------ Contractor's Name-----------------=5 ------------------------------------------------------------------------------------------------------------ Phone.--"---- -------------------------- f Installation will serve: Residence ["Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ ,"I IL g cip—) C� Number`'of living units: __7__ Number of bedrooms _a.-_ Number of baths-,-)._____ Lot size _-P 4 ^_= ______. _y_K_-_�'. -------------- W ---______ Water Supply: Public system [9--"'Community system ❑ Private ❑ Depth to Water Table ______._ ft. Character of soil to a depth of 3 feet: Sand E] Gravel E] 'Sandy Loam F1 Clay Loam El Clay E] Adobe[Er Hardpan ❑ Previous Application Made: Yes [] No [ New Construction: Yes B No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: a, ' (No sep+ic'tank or'cesspool permitted if public sewer is available within 200 feet.) Se ptic Tank: + Distance Jrom nearest well_7)-L4-y1J-_.Distance from foundation___]_Q------______Material-___ _______-______--_. FNo. ofcompartments....-Z----- ----------Size---&-K- x- -Y--------Liquid depth----Zj----------_-------Capacity--- -57J---------- Disposal Field: °Distance from nearest well -___Distance-.from foundation----/-----------Distance to nearest lot line__i�;l-____.. }Number of lines__.____ __________-________Len th_.of'each line:---_�_3__________________Width of trench.____.2 Y_�___--_----_--------- � 5 g _ ,_ 6 Type of filter material____:Yo:�V---------Depth of-filter material-----. .9-------------Total length___________)_(_�___________--_____ Seepage Pit: Distance to nearest w`ell'' ------------------Distancefrom foundation--------------------Distance to nearest lot line____-.__________- l ' ❑ Number of pits----------------------Lining material__- -------t-----Size: Diameter-----------------------.Depth------------------------.-------- - Cesspool: Distance from nearest well----------------- from foundation--------------.-----Lining material------------------------------------- ..J ❑ Size: Diameter--. - ----------Depth =---------------------------------------------- Liquid Capacity gals. � , -- Privy: Distance from nearest well-----------------'---------------- - ---Distance from nearest b0clin 9------------------------------------------------------------------------------ ❑ Distance to nearest lot line--- -------_-------'' ``----------------------------------------------------------------------------------------------------------- Remodeling and/or repairing {describ e}:-_�-=-----�-"-==�-==_=w.-. '=--------------------------------------—----------------I-------------------------------- ---- ------ -----• ---------------------------------1-----------------------------=---------------------------------------------------------------------------------•------ ------------------------------ ----------------- 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 re ulations of the San Joaqui o ai Health District. ; (Signed . --- -----------------------------------------------------------(Owner and/or Contractor) Title_ ----------------------- ----- ( le) - q 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 ` �� ---�---•"-----�------------------------ DATE )L� /� ------------------------------ R - - ._.__. . - E VIEWED BY --------------------------- -----ren DATE BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------------------------------------------- Alterationsand/or recommendations:--------------------------------- ---------------------------------------------------------------------------------------•--•------------------------------ ----------------------------------------------------•------------------------------------------------------------------------------------------------------------------------------------------------------------------------ .... --------------------------------------•--------------•------------------------------ ----"=----------------------- --------------------------------•--------------------------------------------------------------------- ----------------------------------------------•------------------------------------------------------------------------------------- -- ------------------------------------------------------------------------------------ FINAL INSPECTION BY___________________ ___ ___ ------ Date_ _ ---- -r.-----��_ 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.CO.