3125 - Laserfiche WebLink

Home Browse Search

LICATION FOR SANITATION PERr it Permit No. (Complete in Duplicate) pv ! f �? Date Issued sem p is tion is h rebq¢fn e to oaqui L ca Health District for a permit to construct and install the work herein described. This application is made in comp i with Co ty Ord- ante N 0, 3` JOB ADDRESS AND LOCATION__ Owner's Name - - M -------------- Phoneme----------tet _ ------------------------------------------ - - - Address -- ----- ----- --------------------------- ------------•-------------------=----------.----------------------------------------------------------------- Contractor's Name. -f—�� ------------------- ----------------------------- Phone__ Installation will serve: Residenc5,K Apartment House ❑ Commercial ❑ Trailer Court ❑ �M+otel E] Other Number of living units: �_____ Number of bedrooms �" __ Number of baths - ---- Lot size ___�i+-- �_ _____________________ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table,�� ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ f Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 19— / Septic Tank: Distance from nearest well istance/from. foundation-------F------ .Material _ No. of compartments_____�--------------Size�n, ., ,G!l ___Liquid depth.____- _____Capacity___-F -Ude _ ------------- No. -- -- Disposal Field: Distance from nearest wel{I_,��Distance from foundation_�_�� Distance to nearest lot Gne___-. ___._. Number of lines--------_I---------- --- Length of each line-------5-'_V_ iJ-----.Width of trench------02�/_____________----; ` Type of filter material_ ___ ________Depth of filter material____ Total length______:____ _u _ ------------------ Seepa _- Seepa a Pit: bistance to nearest wel ___Distance moation _ istfance to nearest lot line_� ______-_ Number of pits_____/--------------- materiaSize: Dia tr - -------------Depth--- ----------------- Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining material____,______-___------_______________. ❑ Size: Diameter--------------------------------------Depth--------------------------------.------------------- Liquid Capacity-=-------------------------90ls.. •V Privy: Distance from nearest well------------------------------------------------_Distance from nearest building------------------------.____-__________-. ❑ Distance to nearest lot line---------------------------------------------------------------------------- (U, a Remodeling and/or repairing (describe):-- --------==--------------- ------- -------------------•------------- -� -------_::= -------------------------------------------- - -----------------------•-------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San-Joaquin County ordinances, Sta ws, a d ulcs and regulations of the San Joaquin Local Health District. (Signed)------- _,eor --- --- --------------------------------- - - ---------------------------- - ------------------------------(Owner and/or Contractor) By:---------------- ----- -f--11------------------------------------------------------------------------------------------(Title)---------------------------------------------------------------- (Plot 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-----------_-____--_ ------ REVIEWEDBY---------------------------------- ------- -------------------------------------------------------------------------- DATE �1 6 BUILDING,PERRMIT ISSUED------------------------------------------------------- ----------- ------ DATE------_' 'a,--- Alterations and/or recommendations-------------------------- E --------------------------------------------------------------•---- ------=--------------------------------------- '' _ ------------------------- ----------------------------------- ------------------------- ---- ----- -��/ .�- ----------------------------------- ------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------- _________________________________________________________._____________-__-_______________-__---.___-____.__-___________,_________________-__-___-_._____._________________--____________.-_______________________.____ F; FINAL INSPECTION BY----------- -------------------------------------------------- Date----------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Sfree+ 300 Wes+ Oak Street 132 Sycamore Street 814 North "C' Street Stockton, California. Lodi, California Manteca, California Tracy, California E5-9-21VI 8-51 Revised W-2100