12025 - Laserfiche WebLink

Home Browse Search

Co �PPLICAT<ON FOR SANITATION PERMIT Permit No. -_ ._�d -- pl t in Du fiicate) ` 97 b `— Date Issued .. ✓--- ---------- - ! is Permit �Z fires . ear From Date Issued Application is hereby ma e t #'a San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made i co pliance with County Ordinance No. 549. u p JOB ADDRESS AND LOCATION .P5't C *- p"kA - --------- ------ ------� -- -------------------- ------ . f� Owner's Name. S (A*_;I---- . j---------------------------- ----------I-------------- Phone--------------•--------•----------- Address------ 7`Z ------ ' .<------------------------------------------------------------------------------------------------------------------------------------------------------ Contractor's Name, _�5.. •� 1� � Phone.. Installation will serve: Residence ❑ Apartment House ❑ Commercial railer Court ❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms -------- Number of baths _______ Lot size ___97X14-0_____________________________________ Water Supply: Public system [Community system ❑ Private ❑ Depth to Water Table .6 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Er Hardpan ❑ } Previous Application Made: Yes EV"No ❑ New Construction: Yes [V No ❑ PHA/VA: Yes ❑ No 0—' 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---al?--------- -6�j No. of compartments_.____�.._______________Size __`�_`X_6_A'__.Liquid depth__.___j!. -------------Capacity__ _jj9/_ I-Tie o Disposal Field: Distance from nearest well---- ---------Distance from foundation_.YP-------------Distance to nearest lot line_"/___...._ 14 Number of lines____________ _ V-------------------Length of each line------ ,3__-/---------------Width of trench...rZf'__,--------------------- Type of filter material___-74-(�t-________Depth of filter material___.J__P-------------Total length___+_d______________ _ ---------------- Seepage Pit: Distance to nearest well-----_—------------Distance from foundation___ Distance to nearest lot line_ _--____._ 33._ � ________ dNumber of pits------ _7h / ---------Depth__.__.. � ______ Cesspool: O i Distance from nearest well_________________Distance from foundation._._____________--- Lining material_____.______.____.________-___-.--. ❑ Size: Diameter--------------------------------------Depth--------------------- ---------- -----------------Liquid Capacity-------------------------_-gals. Privy: Distance from nearest well----__------------_----------------_-------------Distance from nearest building__________.____________________.._------ ❑ Distance to nearest lot line--------------------------------------------- ----------------------------------------------------------------------------------- --------- O Remodeli and/or re airing (describe):---_'', �+� __�� -- -- -- .cs -- -- F - ---` L------------- ------- ----------------------------------------------------------------------------------------------------------------------- ------------- --------------------------------------- (11 i ---------------------------------------------------------------- A ------------------------------------------------------------------------------------------- ----------------------------------------------------------------- - 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. c�-__l -------------------------------------------------------- ---- ----------I--------------------------.Owner and/or Contractor (Signed)------------------------- ----- { / ) By:----------------------------------------------------------------------------------------------------------------------------------{Title)------- ----------------------------------- {Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). f FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- �'. - ATE------4- -- 2 ----------------------------- REVIEWEDBY------------------------------------------------------------------------------------------------------- ATE---------------------------------------------------------- - BlJILDINGPERMIT ISSUED-------------------------------------------------------- --------------------------------------------- DATe------------------------------------------------------------- Alterations and/or recommendations_______________________________ _ _ ____ _ •¢ - - ---------------------- l---- ------ ------------------------------------- ---- - ------------------------------------ -----• 1 r FINAL INSPECTION BY.---s-.t _.- d`�'- ........ ------------------------------- 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 Revised 8-'59 FY.Cc. 1