11545 - Laserfiche WebLink

Home Browse Search

r APPLICATION FOR SANITATION PERMIT Permit No. �xJ�� (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 is made in compliance with County Ordinance No. 549. a - --- -- ------ -- -- ------------------------------------- ------------- ----------------------- �- '•, `JOB ADDRESS AND LOCATION---- Phoner Owner's Name------ I-- Address-------------------••---------- ---- ---------------- - ------------•---------------------------------•-------------------------------------------- ---------------------- ---------- --------------------------------------------- --------- Contractor's Name--------�T---------4 Phon _ Vl�,_ Installation will serve: Residence �partmenf House ❑ Commercial ❑ Trailer Court [I Motel ❑ Other ❑ Number of living units: __1.-_ Number of bedrooms _'-Z- Number of baths --./--- Lot size _ __/G--.4-------------------------------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam F] Clay Loam ❑ Clay ❑ Adobey Hardpan ❑ Previous Application Made: Yes ❑ tNo,Z New Construction: Yes E] No K FHA/VA: Yes E] No El TYPE OF INSTALLATION. AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic T Distance from nearest well-----------------Distance from foundation--------------------Material--------------- __..__---- ___________------------ I No. of,compartments--------------------------Size--------------------------------Liquid depth-------------------- ---Capacity----------------------- isposal Field: Distance from nearest well------------------Distance from foundation--------------------Distance to nearest lot line-----.----------- 1P ❑ Number of lines---------------- -----------------Length of each line----------------------------- Width of trench---------------------------------- Type of filter material-----I___..__--_--_----Depth of filter material_____________________Total length------------------------------------------ 1 lepage Pit: Distance to of nearest well______LI' v'?['G-DteraalCe from fou-nciation__�G?---------Distance to nearest lot line__�2___----_ P _Size: Diameter--_ - _ _- Depth---;2x- ------------------ ---- ------ 9 1 Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-_________.___-----_______________. �_ ❑ Sizek Diameter------------------- ------------------Depth----------------------------------'-----------------Liquid'Ca�pac i't'y t---------------------------------------- '�- Privy: Distance from nearest well------------------------------------------------- from nearesf`bI ilding__ ❑ Distance to nearest lot line-------------------------------------------- --------------------------------------- ----------_-------------------------------------------- Remodeling and or (r ,rin Idescril,e�: ---- ---•-------- - b 4�/ _. _ ___________ ___ ________ __ --------------------------------- --------------------------- ___ _______ -- i ! f Y ��. ------------------------------ f. -- - ti. ---------------- " ! _ _ - '" 'F ------------------ --- ------ -------- ---------------=-----------------------------------------------------------`---------------- ----------------- --------- `: 1 hereby certify thatI have prepared this application and1hat the work will be done in accordance with San Joaquin County ordinances, State laws, and rules d regulations of the San Joaquin Local Health District. (Signed)..... t ---------------------------------------------------------------------{Owner and/or Contractor) Title i (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------------------ I DATE--_-_-'_ _ ----- - ---------------- ---- ---------------------------------------------------------- - - t REVIEWED BY------------------------------ DATE ' BUILDWG PERMIT ISSUED - DATE---------------------- Alterations and/or recommendations:-------.._---- -- -- - ----•----------------------------- -----------------------------------------#------------------------------ ��/'�\, ------- --------------------•------ -------•----------------------- ---- '! •C _,----_ ,-- -•-'�---- --------" ______ -- -______ ___ _ _ ___ __ '--` '_'^"___ ___A�___ _______ __ ____ _ _ __________ _______ ____.___-___________-____.__________-_-__..____._-_ _ _ - - ------ 'r` #'Tri c . - 4 - ----fir- -7 -- ------------------------- ------------------------------- FINAL INSPECTION BY:_ Date.------- 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 ES-9-2M Revises 1-57 F.PCO.