11331 - Laserfiche WebLink

Home Browse Search

'" Permit No. _-./J_3 3_ --.._ AFPL)CATION FOR SANITATION PERMIT � - ' i J '� � r (Complete in Duplicate). F Date Issued ,ON 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 compliant wit C my Ordinance o. 549. f + . F JOB ADDRES21- OCATION (: �[ "' ' ------ ----------4'-- ---------- ---- Phofie--- - ----------------------- OwnersNam ------------------- ---------•--------------------- - Address Contractor's Name-------•------- � ---------- --yl-�-------- -----�---- one------------------- -------------- --------- - - --- - ----------------------------------- Phone Installation will serve: Residence ❑�Q��Alsart ent House ❑ Commercial ❑ Trailer Court [�Mdtel ❑ Other ❑ Number of living unitsQ'`ly1«um r o bedrooms Nurryber of balls . Lot size _p� -�� s t. Water Supply: Public system ommunity system ❑priva`te ❑ Depth to Water�Table _e 3 Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam'o Clay ❑ Adobe K?-F'Iardpan ❑ Previous Application Made: Yes ❑ No B' New Construction: Yes ❑ No S NA/VA: Yes ❑ No ®.— TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material------------------------------------------------- El ---__------- __--------------------------❑ No. of compartments--- ----------------------Size-------------------------------Liquid depth-------=------------------Capacity----------------------- Disposal Field: Distance from nearest well-----------------Distance from fousidation--------------------Distance to nearest lot line---_-__-----_--_. ❑ Number of lines-------------- - -----------------Length of each line--:--------------------------.Width of french----------------------------------- -----------------------of filter material-------------------------Depth of filter mate.rial--__----_'------------Total length------------------------------------------ Type Pit: Distance to nearest well----_-` '__---Distance fr m f dation____-77 r.Distance to nearest lot line_-_�-- Linin material_,ol e2 -Size: Diameter_---.fj Qsc----Depth- ---�- 4 Number of pits-___--�- _ g \ �esspc?ol: Distance from nearest weV!-----------------Distance from foundation------------------..Lining material------------------------------------- ❑ `3 I+� Size: Diameter--------------------- -- -------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. '1 - ----------------Distancerom nearest building Privy: Distance from nearest well------------- --------- -- - g------------- -------------- ------- 0 Distance to nearest lot line----------------- ----------------------------------------------.---- ll ` ---------------- -------------------------------------------------------------------- Rembdeling and repairing �describe�:---__.- ----- - - --- -- - ---------------------------------------- --------- --------------------------------------- ------------------------------------------- ------1l-- -------------------------------------------------------------------------•-----------------------------------.. F ----f------- ------------ ---- - -------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- f I hereby certify that I have prepared this application and-that the work will be done in accordance with San Joaquin County ordinances, State laws, andrules nd regulations of the San Joaquin Local Health District. – --------------------- ------- ^` -------------(� Contractor) (Si ned 9 } ------------- -- -- ------- f t plan. ShOWIn SIZe Of lot, locationVytem ` (Title}_--- - -- _'13 :------ (Plo I g in relation to wells, buildings, etc., can be placed on reverse side). ' FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------- = � DATE �Q- - 57------------ - REVIEWED BY------------------------------ --- ------- DATE---------------------- ----------- - ----------------------------------------------------------------------------------- BUILDINGPERMIT ISSUED----------------------------.------------------------------------------------------------------------- DATE------------------------------------------------------------- Alterations and/or rgcommendations: --- -- ------ -------------------"-----------------------------"------------ - _ --------- --- �-R-0--------------------------------- -•----------------•---------------------- --.✓ � i ---------------------------------------------------------------------------------------------------------------------- f ~_ ------------------------------------------------ ----__-.---•--------`-------------- ------" FINAL INSPECTION BY:. Date------ 7-r 'f ----------------------------------•---- SAN JOAQUIN LOCAL HEALTH DISTRICT 13o South American Street 300 Wast Oak Sfreet �132'Sycamore.Street �. 814 North "C" Street Stockton, California Lodi, California} 4 #'3'. IXI r.Manteca, California;* Tracy, California ES--9--21+1 . Revisea 1-57 F.P,CO.