9269 - Laserfiche WebLink

Home Browse Search

i0APPL1CATION FOR SANITATION PE' Per No. ....................... (Complete in Duplicated Date Issued ---- " - -----�-- -----�. Application is hereby made to the San`Joaquin`Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance-No. .5,419. JOB ADDRESS AND LOCATION ---------- D t Owner s - e------ - - ---------------- { _.. - = = Phone -•---- 9 - T 4 Address_.-- - T --------•------------------------------------------------- Contractor's Name--•- ----- --------- ----- -------------------------- -------------------------------------------- --- •--..---- Phone.--------------------------- Installation will serve: Residence Apartment House [I Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __I_.:_ . umber of bedrooms -Z- Number of baths _.L.__ Lot size o �-_x-.. ----------------------- Water Supply: Public system Community system ❑ ' Private❑."Depth-to Water Table .::._... ft. Character of soil to a depth of 3 feet:1 Sand .. Gravel [ISandy Loam Clay Loam ❑ Clay E] Adobe �ardpan ❑ Previous Application Made: Yes C] No New Construction:. Yes Mr NNo ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted afublic se er is available within 200 feet. .fit,..^, Septic Tank: Distance from nearest well._��Disf, ce from foundation-_'. ------ r,riaL- _---_ - [ No, of compartments-.-__ _... ---------Size .x- __X_5 ..___Liquid de th_.--_�f'---------------Capacity.-.- Dispos I`Field: Distance from nearest w�elhl.. Distance from foundation �._.-..Distance to nearest lot lingj--___-- [ �__'1_ -_........MLen Length of each line_------- -��.D • Width of trench.._.. 4-..- R. Number of lines__-._---_- _ Type of filter materi ..-- - __,-� D'epth of filter material___._ :$r�#`.='.Total length.............. .---------- ---------------- Seepage Pit: Distance to�iiearest well______________________Distance from foundation___.._..._._.'.:._.Distance fo nearest lot line_....--....._... ❑ Number of pits------------------------Lining material-----------------°------Size: Diameter-----------------------Depth--------------------------------- P Cess ool: Distance _ e from nearest".well__ ____._.._,:'_Distance from foundation--------------------Lining material-----------.--------- ------------- ❑ iameter-------------------------.; -------Depth-.--------------------------- ---- ------------------Liquid Capacity---------------------------gals. Privy.' Distance from nearest well------------------:......---------------------.....Distance from nearest ."" b uilding.-_-,-.-_--.---_.--------_-_-__.___.----. Distance to nearest lot-line - -❑ - ..., Remodeling and/or repairing (describe):--------- __._----_____'._ 4 ------------ ---------------------------------------------------------------------------------------------I------ ---•------------------------------------------------------------------------------=------------•-------_-------•------------------- 1 } ! : --------------------------•----------- ------------------------------------ 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, Stat laws, and rules and regulations of the San Joaquin Local Health District. ----- ---------------------------------------------------(Owner and/or Contractor By-------------------------- - ----------------------•--------------------------------------------------------------------------------(Title)---------------- ------------ ----- '------------------- - (Plot plan, showing size of lot, location-of system in .relation to wells, buildings, etc., can be placed on reverse side). i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -----------------------------•-•---'--------------------=--- DATE BUILDING PERMIT ISSUED--- --- ------------ ----------------- ---------------------------------------- DATE-_ ---- •----------------••--------- ----------------------- REVIEWED BY DATE -------------------------- ---------- �� ----------- Alterations and/or recommendations- f'r- ��- - _�� -----------5,r errs+ �" � �� - �1 .: ---9-4)--•--" �� 7` ----------- ------------------------------------------------ ---------------------------------------------------------•--------------- ------------------------------------------------------------------------------------------------------------- FINAL INSPECTION BY:----�----- -----/"_-- --- _ = == - Date - = SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Stree+ 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revises 1.57 F.P.CO.