9527 - Laserfiche WebLink

Home Browse Search

,� IAPPLICATIO�;F0 R'SANITATION PERMIT, � Permit No. (Complete in Duplicate) Data Issued =/ Q � gtd in Application is hereby made to the San Joaquin Local Health District for a permit to construct stall the work herein desibed. This application is made in compliance with County Ordinance No. S49. yt 04 , ` , - .� . - ------- ', -` -- JOB ADDRESS A D,L DATION____ -n------ ------- Phone ----------------------•-- . . .- _ Owners Name __( __.., " t �, �' -. --------- ---------------------------------------------------Address - - --------- ----------••----------- -----•------- - --- Phone - - Contractor's Name---X70- Y1„h�/____..---•----• ----------- -------------- �. ---------- - Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Mote{ ❑ Other ❑ -2u.-Number of baths ---/--- Lot size ___ e- -Q- ' ;,--:• ------ Number of living units: __.-____ Number of bedrooms s Water Supply: Public system"n "Carrimunity'system'❑' 'Private [>�Depth'to Water Table --____ ft. l Sand Loam Clay Loam lay ❑ Adobe Hardpan ❑ Character of soil to a depth of 3 feet: Sand Grave ❑ Y :No ZNew Construction: Yes 1y No E:] FHA/VA: Yes ❑ No Previous Application Made: Yes ❑ _ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank`or`cesspool permitted if public se er is available within 200 feet.) 4 1 — w Septic ank: Distance from nearest wellp-Distance from faundatian__��.----------Ma�,ter�a!__ �-'------------- Size_ -- _•_._Liquidtdep<th '°."------y.Capacity-9-_Q_0� = No. of compartments--------- s- � �r� to nearest lot line--�- � Distance from foundation_ - - Dispas I Field: Distance from nearest well��Q Length of each line_____:___- _f Width of trench._______ ' `- - -- -- Number of lines _________ _____. g r�----- Type of filter materia --__ ___'_----- of filter ma#erial____._I_ -____ _---Total length_______________ _ oundation_ _-------Dista.ce to nearest lot •n _ Seepage - •-- �+ a (� `� - Njumabee of pi nearest well- Depth mD#eraial_e from ------ --Size: Diameter---- -=-- .Depth-------- ------ Cesspool Distance from nearest well_________________Distance from foundation____.--________---.Lining material--------------------------=------ -Is r ` _� - De anfh r6 ;11 -- ------------ --------Liquid Capacity---------------•-----------gals. `tel ❑ Size: Diameter--:--------------- ----- p % Privy: Distance from crest well--------------------------------------------------Distance from nearest building------:--------.--------------I---------- Q ❑ ------------- ------------- ----------------------------------- ---•-------------:--------- Distance to nearest lot ina_�-------------------- ----- ----------- Remodeling d/or repairing de criLre7:_ -------------------------_��-------------•-------------------••-- .� �i - . ' - _____________________________________________ _------- ------------------------ ----------------- - -�. _�-----•-=--------------- -------- ----------- --------------- r -------------------- -----------------------------T hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County �y d regulations of the San Joaquin Local Health District. ordinances, State laws, and rules an [Owner and/or Contractor} (Signed} ' i � (Tit e) (Plot plan, showing size of location of system in relation to wells, buildings, etc., can be placed on reverse side): \; l FOR DEPARTMENT USE ONLY F APPLICATION ACCEPTED BY--- - DATIy ---------------------------•----------------------- DAT REVIEWED BY----------•---------- ---------- --- --------- DATE-------�'�------------------- ---------•------------------ ----------------------------------- ------ - --- BUILDING PERMIT ISSU _____________ - ---------------- � Alterations and/or recommendations:------ --------------- � --------------,_-.•__----- ------------F----------------------- ---•------- --------------------------------- Date--- ------------------------------------ FINAL •INSPECTION` BY:---`"- f- -- ----------------------------------- -------- - --- ---= -- --�-•---- .. ------ - ----•-------- SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C" Street 130 South American Street TracCalifornia Stockton, California Lodi, California Manteca, California y ES--9-21x1 Revised 1.57 F.P,CO.