10025 - Laserfiche WebLink

Home Browse Search

0 4 '�Y.K APPLICATION FOR SANITATION PERMIT Permit No. Ivp (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 1s made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOC,' ION------- Owner's --Owner s Name_______________ -- - - -- --- ------- --- -- - - - -- - - ---- ----- - Phone------------------------------------ Address..• `-•------------------------------------------------ ---------•---------------------------------------------------- Contractor's Name--------------------- ---r--- - - --- ----- ---------------------- ------------------------------------------------ Phone----------------------------------- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _ ___ Number of bedrooms_. Number of baths Lot sizel_2 . s Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table W-'e ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam "Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes P'No ❑ FHA/VA: Yes [L4- T'�o ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: } a (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) I D� Septic Tank: Distance from nearest well-021rUbistance from foundation----1_4?------Material------ _ - - ' No. of compartments __ ___ _-Liquid depth----�� Capacity____t '` P �-------------Size_ 27 -- r Disposal Field: Distance from nearest will--yj�Distance from foundation_____.,/a______-Distance to nearest lot line__-�w__ __ Number of lines_____________!_ Length of each line________ �' f --- ------- g ��--r��-------�----Width of trench.------ --`-�- Type of filter material____,---Depth of filter material-------le--------Total length______- Seepage Pit: Distance to nearest well-__ 7 '__Distance from fo dation______i��_____.Dist nce fo nearest lot line----a?�____.. (� Number of pits___________________Lining material___#��__-_Size: Diameter__ __ .-_ *t.r_�_D,ept' _- .__2_4 _-__________ Cesspool: Distance from nearest well_________________Distance from foundation-------------------.Dining m�afe'-r"iah El "� Size: Diameter________-------- --------------------De th--------------------__ _ ----_ -__ _ -Li Liquid Capacity- p -- - - --------------- q ---------------------- ----gals. Privy: Distance from nearest well-_________________--------------------_---------Distance from nearest building______________--_________________________ y ❑ Distance to nearest lot line---------------------------- ------------------ ---------------------------------- Remodeling and/or repairing (describer 111 's! --------------------- ------------------- -----------------------•--------------------------------------------------------------------------------- -------------- ---------------- ------------------------------------------------- ------------------••-------------------------------------_-------------------------------•-----------------------------------------------------------•--------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------••----------------------------- - 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 r ulations of the Sa Joaquin Local Health District. L t - (Signed)------------------------ --- A ----- ------------------------------------------------------------( ontractor) By:-------------------------------------------------------- ---+�-- - ----- (Title)-------- --------------------- (Plot plan, showing size of lot, location stem in relation to wells, buildings, etc., can be placed on reverse side). " FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY____ _ _ -_____ DATE_______ 5-� - -- -- ------ -- --------------------------------------------- -- REVIEWED BY - --------------------------------- DATE------ --- ------------------------ BUILDING PERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE Alta afiTs and/or r T endati�or s:- -I -- f - - ------------- -- ----------- -----•--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------- -19/ FINAL INSPECTION BY:------------------------------------------------------------------------- .�� Date-- --G1 - ' SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street $14 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES--9--2M , Revises 1.57 F-P,CO.