14685 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: f -_ -...�- ------------ -;- �--- APPLICATION FOR SANITATION PERMIT Permit No. ----------- ----- --------------------------------------- (Complete in Duplicate) -_____ ------------------------------------ i This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work he ein descri d. This application is made in compliance with County Ordinance No. 549. 12.sta 5` sT �EP : - French Cam S-W corner of Hi Way 50 Rt 1 Box 1855 P JOB ADDRESS AND LOCATION--------------'-._.._...-----...---------...-----�----•-------•--------------------------------------------•-•------ Owner's NamesT_c';1 .._Haye._e2'a HYTE__F! ._-'aI'YCiS---TI1C Phone-----------I ---31+243- Address.......................................... ame----------------------------- •------------•---------------------------••-----•----- Contractor's Name....The ]?AX._&••NIGHT Septic---Tank Service .--_-_,____.... Phone_5Q_6__3$41------ Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ZK Number of living units: ...*__ Number of-bedrooms #_._ Number of baths _?k.... Lot size .__._.A-cQragH------........................... Water Supply: Public system ❑ Community system ❑ Private E Depth to Water Table ---22 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy LoamXX Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,dote---------_----------) No ❑ New Construction: Yes ❑ No IX FHA/VA: Yes ❑ No ❑ ry TYPE OF INSTALLATION AND SPECIFICATIONS: N (No septic tank or cesspool permitted if public sewer is available within 200 feet.) SAptic Tank: Distance from nearest Distance from foundation.-_20! (:C Brf c� a t�rlel y 640Ga1s .tQ No. of compartments---all€�__1--------Size..51�;_id,__R.-7 'Liquid depth......----------------capacity................ .---• [r� ex1$T� keg 501 t , Dis osa field: Distance from nearest well___. Q1_.__...Distance from foundation-_-_i_1D!------Distance to nearest lot E=ting Number of lines___________-.--------------------Length of each line----lQQ...__. Width of french.........2......4 ________ & Add Type of filter materia$_e.pt1_c__R�Depth of filter material---------10-'__-___Total length.....................IN....._._.._ � Seepage Pit: Distance to nearest well----l0Q=------Distance from foundation--- to nearest lot line--------3-0_t. I-Z MC Number of pits-------1-----------Lining material...RQck--------Size: Diameter--_._33"-!.-..---- Depth--------.12.=--------------- ' Cesspool: Distance from nearest well-----------------Distance from foundation-------------------.Lining material--------------------................. ❑ Size: Diameter---;------------- •---------Depth----•--•--------------••------------ •-----Liquid Capacity---------------------------- Privy: Distance from nearest well _____________----------------------------.------Distance from nearest building-________-__________-_-_--___..____---... ❑ Distance to nearest lot line---------------------------------------------------------------------------•-•-----.------•----------------------------------- -------------- Remodeling and/or repairing (describe):__--dding__one__C_ $ar�.�?ent--_to_-existir>g single compt. -•--•-sattali-ng----tanX..and---adding--.auptle-mentary...drainage.,•-•---•---fif--IS -BED S--BGG--WASHER. ---------------------------------------------•----------------------------------------------------------- --------------------------------------------•-------------------------•------------------------------------------ I hereby certify that I have prepared this application and that the work wiV be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the S quin Local He Ith District. (Signed)--- The._DAY.& NIGI$_ Septic Ta Ser i e r Contractor By:-------------------•......-----•--• ----------------------------- --- - (rifle)---------------------- ---------....... ---......------. .. (Plot plan, showing size of lot, location of system in rela 0 to wells, buildi s, etc., can be placed on reverse side). FOR EPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------------- ----------------------•-•- DATE.-------------- �c REVIEWEDBY------------------------------------------------------------------------------------------------------------------------------ DATE------------------------------------------------------------ BUILDING PERMIT ISSUED--------------------------------------- --------------------------------------------------------- DATE----_---------------•- Alterationsand/or recommendations:------------------------------------------------ ----------------------------------------------------------......----••----•...-----•-•---------•------------- ----------------------- - --------------• -•---:yr��--!---• .----------- `''-y-- ---- -- ---•-----------------------------------------------------------------------_-_--------------------------.- _......•--•-----------•.......................•---.._......-.----------•--- ----------------- ---------- .................--------------------------------------------•----• - ----------------•-•-----------------------------------------------------------------------------------------------.....----------- ------------------------------------ ----------_._...---------------------- FINAL .__... ------FINAL INSPECTION BY:- Date - =�/• `R =-• •-----•---•---•---- SAN JOAQUIN LOCAL HEALTH DISTRICT *,k - 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Monmea,California Tracy,California €5 9 REVISED 6-59 YM 8.51 ATLAS