13245 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: _ - APPLICATION FOR SANITATION PERMIT Permit No. _...J_.. 2=Y5 ----------- -------------------- -------------- (� ------------- ------------------------------------------ (Complete in Duplicate) Data Issued ----------------- ----------------------------------__- I This permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein descrbedv This application is made in compliance with County Ordinance No. 549.We ! JOB ADDRESS AN LOCATION.. ' -K Owner's Name --•a ...... Phone ----------------------------------------------- Address. ------------- ------- --- - Contractor's Name-------- ----------- -•-•------------- Phone...............-------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ TraileyrssCourt ❑ Motel ❑ Other ❑ Number of living units: ___..._ Number of bedrooms -`Number of baths ---_ Lot size ....� _ --------------------- of eor Water Supply: Public system ❑ Community system ❑ Private IIx Depth to Water Table 1,V-Tt. Character of soil to a depth of 3 feet: Sand ❑ Grave Sandy Loam 4Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date------r"- No New Construction: Yes No ❑ FHA VA: Yes r No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) kepticp�Tank: Distance from nearest well-----------------Distance from foundation-------------------Material_-__--..------_---------..-_----------------___-. 1 No. of compartments--------------------------Size------•-----------------•-------Liquid depth---------------- ---------Capacity------------------••--- 1, ` i 9 Disposal Fiel Distance from nearest well---j--6--.-Distance from foundation---. .....--Distance to nearest lo� _._...__..._ Number of lines------- =l____ Length of each line__ -_-_9)1 f.r__..Width of trench._-__ _ _____________________ Type of filter material__ .1._ ' 4-Depth of filter material-----L.. Total length-.--__—--ne .............__-.-__._ ��.--_.Distance to nearest lot line---7�' -.-- 01 page Pit: Distance to nearest weli----- �---------Distance from foundation____-. Number of pits------/--------------Ura ---Size: Diameter---3-2(10-----Dept h------ "1 spool: Distance from nearest well--------7��ndafion.-.._._._._..______.Lining material_.__.._.________.._________.__._____ r 0-- El Size: Diameter----------------------------------------Depth-------------- -------:----------:----------- Liquid Capacity gals_ 9 Privy: Distance from nearest well--_----------------__--------- ..---------Distance from nearest building------------.-.--__---_-----_----..------- ❑ Distance to nearest lot line-------- --------------------- •------------.-. --------••-•---------- •----------•----------------------------------------- r Remodeling and/or repo'ring (describey:_ � 1 �' ---- - ,'j wl �` � < .. -- .-------- " 1' ----- ------- -----------=-------3 ,,. � ---- ---------------------------------------------- - --------------------------------- --------- ----------------•-------------------------------•------------ ------- -------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------ - ---------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby cert that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances State lam? anZr es and regulations o'f the San Joaquin Local Health District. ------------------._Owner and or Contractor(Signed) 1� �f_ .^e� { I A ------------------- - -- ----------------------------------- Title ll (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 APPLICATIONACCEPTED BY----------------------- --------------------------------------r"", ---•---------------- DATE--------------------- a ------------------------ REVIEWED BY--------------------------------------------- ----------------------------------- -------------------------------- -^--- ----------------------------- DATE '` c! ---- --•--------------------------- BUILDINGPERMIT ISSUED------------------------------------- k-4— _ DATE.. ------------------------------------------------------ Alterations and/or recommendations---------------------- ---------- ------------•----------------------•-----------------.-.-------------------------------------------------------------------------------------------------------- ----------- --------------- ----- -- ------------------- -------------------•----------- —:; FINAL INSPECTION BY: -------s � - - -- -------- - Date------. .. � . --------------------------• . SAN JOAQUIN LOCAL HEALTH DISTRICT , 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E6.9 REVIGEc 8.59 r.P.c9.2M 6-60