9611 - Laserfiche WebLink

Home Browse Search

d APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) 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. 549 �/ • ,O JOB ADDRESS AND LOC 10 _._ . - Owner's Name----------------- + r Y�'/�------------------------------------.,,�-- - --------------------.-. Phone------------------------------------- Address_ . � ! - t ---------------- --------------------- Contractor's Name-------------------ltl7- ---•---- ------------------------------------------------•------------- ---------------- Phone.......------------- -------•-- -:installation will serve: Residence ❑ Apartment House ❑ Commercial F] Trailer Court [-] Motej E] Other Other � Number of living units: _ -.--- Number of bedrooms ---- Number of baths I___ Lot size ___rlY-A----4ye_ ___________________ Water Supply: Public system ❑ Community system ❑ Privatej�epth to Water Table&a' ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam [] Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No ] New Construction: Yes No ❑ FHA/VA: Yes ❑ No ❑ _TYPE OF INSTALLATION AND SPECIFICATIONS: _ _ {No septic tank or'cesspool permitted if pubic se, er is available within 200 feet.l Septic Tank: Distance from nearest well-,:5d. ta n c§ fro f uru:latio�e)_'}'±i�4Material_--___ __1704/ y ---•-------.-- No. of compartments Size___ ` -- ----�J-----.Liquid depth----- ----------:_Capacity--- �. _--- r r,�,r.r�. Disposal Field: Distance from nearest well'„�.e)_____._ni ance from foundation.,l�"}�nDistance to nearest lot Number of lines_________ ______ _ F Length of each line-_ -5 of trench____ 4-v Number of filter material_- Depth of'filter maferial-.___ Total length------ :_-_t-_ ___---_.__--_-___-_- Seepage Pit: Distance-to nearest well-----------------------Distance from foundation--------------------Distance'to nearest lot line----------------- F1Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depih---------------------------------- Cesspool: Distance from nearest well-________________Distance from foundation......_.___.__.__-..Lining material------------- _-_-._____-.-_-_-___ ❑ Size: Diameter------ -------------------------------Depth---------------------------------------------------Liquid Capacity ---gals, Privy: Distance from nearest well----_--------------------------------------------._Distance from nearest'buiiding____I------------------------------------ ❑ -_. .Distance to-nearest lot fine------------------------------------------------ -------------------- -- R - -. -- - ' ___________________________________________________________________________________________________„__..__.__ -------------------------- -------------------------------------- -------------------------•--------------- •-------------------------------------------------------------•----------------- I hereby certify that I have prepared this application and that the work will be done in accordance with'San Joaquin County ordinances, ate aws, d roe and regulations of the San JopqjPth Local Health District. Sined "} -- -------------------------------------------Owner and/or Contractor) ( 9 ) - -------------------- - -- ----- -.1. -- y _ • (Plot plan, showin size of lot, Iocatron of s stem rn.relatron to wells, building_--------� --(Trtle).-_.__._-�.__=_:`__--._-�-__�:_�`� p g y s,'efc., can be placed on reverse side). F9A DEP . ENT °SE ON r APPLICATION ACCEPTED BY------- 7__ ----- ---- - t_ --- ------• ATE-------- --------- a ---- - . REVIEWEDBY - ------------------------- ---------------------------------- DATE..---------------•-•j---------- ' BUILDING PERMIT ISSUED-----------•------------------------------------------------------------ ----- ”: DATE -----------------``� --------------- Alterations and/or recommendations:-------- •--------------------------------------------- -------------------- -•--------•---•---- ------------------- ------ -------------------------- = ----------------------•---•- --------- . FINAL INSPECTION BY:.._ = - _ Date------ :r-- - = SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American•Street 300 West Oak $free+ 132 Sycamore Street 814 North "C" Street a . Stockton, California Lodi, California Manteca, California Tracy, California ES-9-21x1 , Revisaq 1-57 F.P.CO.