13293 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. -13— (Complete in Duplicate) Date Issued - > - Ff S This Permit Expires 1 Year From Date Issue Ost Z3o— ------ 09 Application is hereby made to the San Joaquin Local Health District for a permit to con tan install the work herein described. This application is made in compliance with County Ordinance No. 549. ' � lop ------------- ----'" JOB ADDRESS AND L CATION____________ __ ___ ----------- i _� . .. .� . r; I Owner's Name--------- ----- �• --------- ------ ------------------ -- ------ ......... Pho e.: - Address------------ -- .. e --- ----- ---- 5--------- --- -- -- - ------- - •-•- -------------------------- --- -- - -- ----------•--------•--- Phone. 1 - 1.Contractor s Name-------- Installation will serve: Residence, ] Apartm t House ❑ Commercial 0 Trailer Court ❑" Motel ❑ Other ❑ 9..f �4. ;Number of living units: -1_____-Number of bedrooms._._ Number of baths __.___ Lot size _____f_C_ ------ `---l__71_C__---------------------- Water Supply: Public system-E] Communi"+y'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 Previous Application Made: Yes10 No New Construction: Yes ] No L] = FMA/VA: Yes [j No F-1 T . TYPE OF INSTALLATION AND SPECIFICATIONS: r (No septic tank or cesspool permitted if public sewer is available within 200 feet.) l � � Septic Tank: Distance from nearest well___�_._0-___Distan e from foundation____/S--------Mate ial___-________________ ___________________________ �„. -/� No. of compartments-------- ---------sSize_7.. ---- Liquid depth------- - -----�--------Capacity__. d---- Distance from foundation___ _. S ,S__________. Disp�osral Field: Distance from nearest well---- ��____ _._.Distance to nearest lot r Number of lines------------- Length of each line--------0---------------Width of trench.___ F Type of filter material_._..__ _ . _______Depth of filter material ._.__-t*9.._____..Total length-_--_--_- --2-4-------------------- Seepage _________________Seepage Pit: Distance to nearest well----1.7 r-_-Distance from fo//undation__--A,0__r___-Distance to nearest lot line-5-__r___- i r Number of pits__-----I----------Lining material___ s#L.-Size: Diameter---9.7------------Dept --___________________ Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining materia------------------------------------- ; El Size: Diameter.----y-------------------------------Depth---------------------------------------------------.Liquid Capacity----------------------------gals. __-________Distance from nearest building ' Privy: Distance from nearest well_ -- --------------------- g---------------------------- ----- ❑ Distance to nearest lot line--------- --•-------------------------------- ---------------------------------------------------------------------------------------------- Remodelingand/or repairing {describe}------------------------------------------------------------------------------------------------- -------------------•------------------------------------ =1 ------------•--------------------------------------------------„ ----------------------------- ------------- ---------------------- --------------------------------------------------------•--------------------•---------------------------------------------------------- ------------------------- ---------- ----------------------— -----------•--------------------------------------------------------------------------------------:----------------------------------- . 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. //) —�i (Signed).. - ------------------------------------------------- Own - or Contractor By:-------- (Ti+le) (Plot plan, showing size of lot, location of system in rely ion to wells, buildings, etc., can be placed on reverse side). r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------- ------------------------------------------------------ DATE-- --7,-2—? --6-J---------------------------- REVIEWEDBY-------------------------- I DATE------------ .----------------- -- - - BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE--------------------------;---------- -----------•---------- Alterationsand/or recommendations---------------------- --------------------------------------------------------------------------•-••-------------------------•--•-----------•------------------ -._. f ----------------------------- --------------------------------------------------------•----------------•----------•------------------------------•-•------------••-----------•--------------------------------------------- ------------------------------ ------------------------------------------- -- - ------ -----•--------------------------------------•-----------•- ------------ -------------------•------ --------------- FINAL INSPECTION'BY: _ .. -- Date.. f - --------- --- --------- ---------------- ---- ISAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore'Street 814 North "C" Street Stockton, California I Lodi, Californias .._4 Manteca, California" Tracy, California .1 ti ES-9 2M Revised 9-'59 F.P.Co.