4556 - Laserfiche WebLink

Home Browse Search

i Y Permit No. --- ------ �'` 5 APPLICATION FOR SANITATION PERMIT . _ (Complete in Duplicate) - Date Issued/I.. ._�-5 Application s y reby made to the San Joaquin Local Health District for a permit to construct and install the work er in described. This applicatl is made in compliance with County Ordinance No. 54+9, JOB ADDRESS AN�D�fjLOCATION �------- ..l---i� �----- --------- / Owner's Name-----u�/�L. n-1 Address----------- ..._� ------ - ----- a e----------_----------• ------------------------------------- ---------------- _ Phone------.---------------------------- Contractor's Name..---- Installation will serve: Residence a�-<partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other 0 _-- Number of baths �__-. Lot size ---_fo-- --, 1/--d--------°--•----------- Number of livingunits: _ --- Number of bedrooms . ,� ,. Water Supply: Public system ❑ Community system ❑ Private [Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand PGravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay N Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No 3e New Construction: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: ' (No septic tank or cesspool permitted if public sewer is ayflable withip 200 feet.) b �l � I o be a sndQ►� istance from foundation. ! Material._ r Septic Tank: Distance from nearest well....z --- , No. of.compartments-----�- Size__9: ----------Liquid depth Capacityv' Q • �-_....Distance to nearest lot line.fl� +_*_ Disposal Field: Distance from nearest we0--- ....Distance from foundation-._. - Number of lines------------/---------µ$�-„Length of each line-----.--141 ----------Width of trench-----7 -�^-------------------- Type of filter material �fC,_�___�C.Depth of filter matenal.:..._SP_.__..__._.Total length__..._.._ -r.-.-------------------- '�r - _ ...Distance to nearest lot line"................ Seepage Pit: Distance to nearest well..................."..Distance from foundation___._..._..._.._ Number of pits--- - ---------------Lining material-----------------------Size: Diameter----•------------- ---.Depth_....- --�- -----------� � Cesspool: Distance from nearest well__".-_.-__-...._Distance from foundation.-.._..............Lining material.__..".". ---- --- als. i ❑ Size: Diameter---- ---------------------------------Depth----------------------------------- ------------- Liquid Capacity----------------------------9 Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-------------------------------------- ❑ Distance to nearest lot line----------------------------------------------------------------------------------------------------- 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, State laws, and rules and regulations of the San,Joaquin,Local Health District. (Signed)----• -•- ------------------ ----- ----/Z---- ----- --- ------ - ------- -----.-__.(Owner and/or Contractor} By:--------------------- ------•----------- --------- ---- - 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 I lip 11151! 116 APPLICATION ACCEPTED BY-- --- - -------------- - . s t -' DATE------I.�r`'_ ..'" ----------------- REVIEWED BY------------------------------------------------------ ----- --- ------------------------- ----------- ----------------.. DATE----- ------------------------------------------------------ BUILDING PERMIT ISSUED------------------- ----------- -- � ------- --- ------ ----- -- DA�------------ Altera ions and/orrecomLm endatians: ._.__."___'e. �---- ---------------------�-- -- ------------------------------------------------ ------------ ------ ------- ------ 1 --- _ - s FINAL INSPECTION BY---------- -----"-- ---•---- ----------- --� - Date -�------------------------------------------ SAN JOAQUIN.LOCAL HEALTH DISTRICT 130 South American Street 300 Wes+ Oak Street 132 Sycamore Street 814 Nor+h "C" Street Lodi, California Manteca, California Tracy, California - Stockton, California • ES-9-2M I0-52 Revised W-2100