10392 - Laserfiche WebLink

Home Browse Search

`" ,/ APPLICATION FOR SANITATION PERMIT Permit No. .-�_d r (Complete in Duplicate) Date Issued -_--- -Y,I-S�- V 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. JOB ADDRESS AND-LOCATION--,,------3ll---So-•---Wagner,-._.StQCkton Owner's Name S ----------------- Address---------------------------------- iSame -------------------------------•----------------------•--------------------------•------------------------------------------••-----------•----------------------- Contractor's Name------- .AY--&--NIGHT--SEPTIC---TANK SERVICE -------------------------------------- Phone..UPWa--rd-----2.7046 ---------------------------------------- Installation will serve: Residence$l Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __1--- Number of bedrooms __2___ Number of baths ---1__ Lot size ------6Qt-.-x__--_1251r----------------------- Water Supply: Public system ❑ Community system ❑ Private$j Depth to Water Table __5O ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe IK Hardpan ❑ Previous Application Made: Yes ®I No ❑ New Construction: Yes.E] No& FHA/VA: Yes ❑ No ❑ Supplementary TYPE OF INSTALLATION AND SPECIFICATIONS: Fain (No septic tank or cesspool permitted if public sewer is available within 200 feet.) i Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material---------------.-------------------_-----_------. Esti-ng No. of compartments------------- ------------Size--------------------------------Liquid depth--------------. Capacity_-•------------------ Disposal Field: Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line----------_------ , EEIxting Number of linesC---------------------------------Length of each line-----------------------------Width of trench.--------------------------------- Type of filter material-------------------------Depth of filter material----------------------- otal length--------_------_----__-__---_-_-----_----- I Seepage Pit: Distance to nearest well___ _OQ -_____ Distance from foundation---__]Q ------Distance to nearest lot line-----5.'------_ v,1 �] Number of pits.!-.1---------------Lining material--R-o-ek--------size: Diameter-_-- 3'.:..----.---.Depth--------2-51-------------_--- \ Cesspool: Distance from nearest well------------ ---Distance from foundstion.-------------------Lining material------------------------------------ ❑ Size: Diameter-- ----------------------------------Depth,------------------- -----------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest weft-------------------------------------------------Distance from nearest building--_.---------__-_-----_----.---_----. ❑ Distance to nearest lot line------------------- --------------------------------------------------------------------------- ---- Remodelingand/or repairing (describe)-------------------------------------------------------•---------------•--•----------------------•-------------------------------------------------------- -----------------------------------------------------•------}-------------------=-------------------•------------------------------------------------------------------------------------------------------------- I ----------------------------------------------------------- -•-------•---•-------------------------------I---------------------------- ---------------------------------------------------------- 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 the San Joaquin Local Health District. (Signed)----DAY--&- NIGHT---SEPTIC--TA_NK SERVICE ------------------( Contractor) i BY•-------------------------------------------�--------------------------------- - -- ----------t ---------(Title)---------------------------------------- ----- (Plot plan, showing size of lot, location of system in rel f n to wells ., can be placed onreverse side). r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED B _ ) _ DATE-�-----•------------------------------------------------ R EV I EW ED BY------------------------------ -----------------------• - I DATE--' -------------------------- BUILDING PERMIT ISSUED--------- -------------------------------- --------------------------------------------------------- DATE----- --•---- ---------------------------------------- Alterations and/or recommendations: -----------------------------------------------•--- ---------------•------------------------------- 1 - ---- ----- --- -- --------- --------- ------------------------------------- / �' ------------------------------------------------------------- ---- 1 ------------- ------------PA--------------------------------------------------------------------------------------------------- ------------------------------ FINAL INSPECTION BY:- - :------•---- '------ ---------a----------- ---- Date----.-.---------------------------- -------- --------------------- - ---- - SAN JOAQUIN LOCAL HEALTH DISTRICT s 130 South American Streef 300 West Oak Street 132 Sycamore Sfreef 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revises ;-57 F.P.CO.