11498 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. -- 1.7-_-/.O_.• (Complete in Duplicate) Date Issued ----------��_ Application is hereby made to the San Joaquin Locale Health Districf 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 LLOCATION.------- fQ ---- -- - /Zn��---------------- "� -- �Owner's Name----- C � - ----- Address------ ------ -------------- )------- --------------------- J� I -)--- -- ----•------ ---------------- -- Contractor's Name---- -- __-- ---- __-- r-�ll- _ ----4�-.- ____---__---- Phone Installation will serve: Residence artment House E] Commercial E] Trailer Court [:] Motel „❑ Other E]Number of living units. _/--- Number of bedrooms _ -__ Number of baths /--- Lot size __, _ ._._------------------------ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Tableo&n4 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeK Hardpan ❑ 1 Previous Application Made: Yes ❑ No/Pd New Construction. .Yes ' No ❑ FHA/VA: Yes ❑ No Nr TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) ; ,Septic Tank: Distance from.nearest well-----------------Distance from foundation-------------------Material------.-------..---_---._-.._______---.._--. l No. of compartments--------------------------Size------------------- ---- Liquid depth----------------=---------Capacity----------------------- Disposa field: Distance from nearestwell,,7-t-t— _- --Distance from foundation �_�--f-k-.Distance to nearest lot line5........ Number of lines----_--•---------------------------Length of each line--------------------------_---Width of trench--------------------- _4 Type of filter material---__------------------Depth of filter material-----------------------Total length--------------------.-----------____-----_ See a e Pit: Distance to nearest well. -----Distance from fo p g - __-- __- �' dation-,�Q._-.-�-_--.Distance to nearest lot line------ -____ Number of pits------- ---------- --Lining material--. -rr-r Size: Diameter------- -`.�______Depth- 5- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material--f----------.---------------------- Size, --- --__Size: Diameter------------------------- ------Depth-------------------- ------ ----------------------Liquid Capacity!---------------- gals. O'V ,_.,rivy: Distance from nearest well-------------------------------------------------Distance from nearest building----------------_-----_-----_-------__.-. ❑ Distance to nearest lot line------------------- -------------'=----------- ----- ----------------------------•--------------------- --- Remod n, -or repairing (des cribe):--- '�� !3—� �..:.r ------------- --------------------------------------- - - - - -- --- ordinances. State laws, and rules and - this a of the n J -; ---- ui -- --- - -- - ------------------------ ---- I herebycertify that I have prepared this application and, that the work will be done in accordance with San Joaquin County Y P P PP a quip Local Health District. - 1 / - (Signed) pd/or= --- — ------------- ---------=-------(Owner Contractor) _ Title) ------------------- By: - -[ (Plot plan, showin 0 anon of system in relation to wells, buildings, etc., can be p cad on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED ---------------------------------------------------------------------- DATE----- . = REVIEWEDBY--------------------------------------------- -------------------------- ---------------------------------------------------- DATE------------------------------------ ------ BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations:------- -----`= LL' --•-------------- ------------•------------------------------------ ----------------------------------- -T_--=---- - WrH -----.-K-r�'x-, _.--,---------- s ----------------------/ t�EA --------- �` t`5� ,it, ---------------------------------=,-"----------------------------------------------- --------------------- - --------------- ----------------------------------------------------------------------------------------------------------------------------------------- t F f' /FINAL INSPECTK5 a Date-- ------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT i30 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California A� ES-4-21x1 Revised 1-57 F.P.CO.