12237 - Laserfiche WebLink

Home Browse Search

�0 APPLICATION FOR SANITATION PERMIT Permit No. _._l._ _.7--- \ , { i (Complete in Duplicate) This Permit Expires 1 Year From Date Issued Date issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and instal the work herein described. This application is made in compliance with County Ordinance No. 549. T JOB ADDRESS AND L ATION__�e)-- --------------- r Owner's Name--- --------------------= - ------ Phone -------------- -- Address------------- %.._ --- --- --•-------- Contractor's Name______.__________.___.._y_ ~� ----- � '_'�`-. --------------- Phone - --------------------------------------------- Installation will serve: Residence Apai•tmerit,,'House ❑ Commercial ❑ Trail_ej Court E] Motel L] Other ❑ Number of living units: -J--- Number of bedrooms _ •- Number of baths f�Lot size -f ?-------- ---------------- Water Supply:. Public system E] [�Community system rivate [I Depth to Water Table//�ft. Character of soil to a depth of 3 feet. Sand Gravel Sand Loam Clay Loam Clay , ❑ ❑ Y ❑ y ❑ y ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: YesNo ❑ Fl-!A/VA: Yes No ❑ . 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_.'__/e--------Materia, e,�-�djf No. of compartments____ �----------------Size_46X'_-2/K-_f Liquid depth - � q p ' ---- --------Capacity._/XeA-0--- Disposal Field: Distance,from nearest well----- Distance from foundation__'':�JP- --_-Distance to nearest lot line_��7_f.__ Number of lines_____________ _. Length of each line___ __ _ _ 9 I&Q------==------.Width of trench------A Type of filter material-_/ Depth of filter material___ Total length_____.__ �- 1 � e----------- -- Seepage Pit: Distance to nearest well___._e9V,65----Distance f undation_____f Distance to nearest lot line__.__ Number of pits-------- Lining materia____-_ Size: Diameter__.__ Cesspool: _`_--__--Depth_-_..z �---------------- Distance from nearest well_________________Distance from foundation_...________.__-___.Lining material -__-_____.____--_____.____________- F ❑ Size: Diameter------------------ ---------------------Depth---------------------------- - - ----- -- -- -Liquid Capacity----------------------------gals. Privy: Distance from nearest well__________________ ___________-_---------_ _ Distance-from nearest building ------------------------------------------ 0 Distance to nearest lot line_____________________-._.- ------------------ --------------------------------------------- s 3 Remodeling and/or repairing (describe):----------------- ------------------------------- ------- - ----- _. � - -----„ _�- -- ----------- . - -- -------------------------- --------•----------------------•------------------------------•------------------- - ------------------------ --- ---------------------------------- -- -------------------------------------------------------•- - ---------------------------------------------------------------- -- 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, and rules and.regulations_of the San..Joaquin.Local Health District.. _ x. (Signed)------------------------ ---- -------- --------- -- ----- ion roc - - ------- By:-------------------•------------------------- _ ' Tale of plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY, APPLICATION ACCEPTED BY-_-- :_-- - ---- ---- --- �� - ----- --------- DATE.--------` lP DBY------------- ----- -------- ---- - - - - ----- x ...DATE- ------------------------------------ ATE f ----------------------- BUILDING PERMIT ISSUED--------------------------------- - ----- ----------------. DATE - A terations and/or recommendations:------------------ ------------ - --------------------=-------- --------------------- ----- --------------------------------------- ----------- ------•---------- �' C- ----------------------------------- - --- --- -------------- ----- ----- FINAL INSPECTION BY:___ --- ------ Date---- FINAL 1./.•_= C SAN JOAQUIN LOCAL-HEALTH DISTRICT 130 South American Street 300 Wast Oak Sfre_ef. ' `-4 132 Sycamore Str®eb 814 North "C" Street Stockton, California Lodi, California Manteca, California * Tracy, California f ES-9-2M Revised 8-'59 F,P.CC. �, J