10161 - Laserfiche WebLink

Home Browse Search

4 APPLICATION FOR SANITATION PERMIT Permit No- ------------------------ (Complete in Duplicate) Date Issued ----A------1-----•--- Application is hereby made to the San Joaquin uin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinanc o. 549. 1 --------------------------------------- ------- JOB ADDRESS AND LO --------------------------------------- CATION - ..i Phone------------------------------------ --------- Q O - - -------t -;4_Owner's Name----------- l--- z " Address_---- --•---------------SAA-4 .- ---- ---------- ---------------------------- ---- ------------ - --------•--- � � pI__Y-, -. ------.- Phone, p ; Contractor's Name-- '-----•----•-- Installation will serve: s Residence ❑ Apartment House ❑ Commercial 04 Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms -------- Number of baths -------- Lot size Water Supply: Public 4_system ❑ Community system'❑'-'Private"x Dep#h'to Wa#er Table ---- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan.❑ Previous Application Made: Yes ElNo New Construction"Yes ❑ No V FHA/VA: Yes F] NoV TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) i Septic Tank: �Distance from nearest well------- Distance from foundation______________ _____Material_-_-.---__________.___..---------------------•- ❑&1 Sri No. of compartments------------------ i-----Size-•----------------------------- Liquid depth Capacity i kjj -.Distance from foundation--'-_Q-- Distance to nearest lot line--__+ P--_----. l Disposal Field: Distance from neare.W` well_._ Q_ - ;i Number of lines__-- ___ _I ±j"" Length of each line--_----_4-C-------------Width of trench--- ------------------ Number ------------- - -� F �ry Total length _ Type of filter maferial---I_f l/tom$ -Depth of filter material------/9__-----_- g re-------------•------•--- " Distance fo nearest lot line-----_.-_--_-..-Im Seepage Pit:, Distance to nearest well--------------------`-Distance from foundation---- . 0O'r ❑ k Number of pits'---------------------Lining material-----F Size: Diameter Depth r ; Cesspool: Distance from nearest well--------------'_Distance from foundation-----_____-----_---.Lining material-----_.__-- ----------els. ❑ -------=-Depth"-:-------------------------------------------------Liquid Capacity g Size: Diameter-�______________________ ___ i, Privy: Distance from nearest well---------------_---------�.-=------------ .-Distance from nearest building--------____----_-------_-.-.------------ r� ❑ - ---------------- Distance to nearest lot line.--------=---=---------------------- ---------- Remodeling and/or repairing (describe):-_-_--- -- ------------- - ------ --- - I - a---'.I r. ----------------------------- , ----- -------- - ---•• ----- -- ---------=----------------•---------------- ----- ----------------------------- ---------------------------------------------- I -----:--- --------------------- I hereby certify that a e prepared this application and tha. the work will be done in accordance with San Joaquin County ordinances, State laws, d r es and reg ions of San Jo uin Local Health District. W_ __ -----------------------------------(Owner�andfor Co tractor) • ----- - - - ------------ ----- -- . -- --- ----(Signed) 4 wells bu- ---- e -__-----( ------------ Ti}le}__.____ ---------- By:__(Plot plan, showing size of lot, location of system in relation to g tc., can be place on reverse side}. ,5 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------- -------------------------------- ----------------------------------------------------- DATE-------------- ----------------- ---------------- REVIEWEDBY--------------------------------------------- ------ - ------------------------------------------ DATE----- ------ --------------------------------------- BUILDING PERMIT ISSIIED--------------------------------- -- - ------------------------------------------------- DATE------------------------------------- ----------------------------------- Alterations and/or recommendations:--------------------------------------------------------------------------------------------------------------- -------------------------------- -------------------------------------------- -- - - --- --- ------------------------ = Date------------------ ----- ----- `-3-'-----------------------•-------------------- FINAL INSPECTION BY::--------- ------------ ------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street f 32 Sycamore Street 914 North "C" Street 130 South American Street Trac California Stockton, California Lodi, California Manteca, California Y. ES-9-2M , Revisea 1.57 F-P.CO.