11936 - Laserfiche WebLink

Home Browse Search

�-�-- APPLICATION FOR SANITATION PERMIT Permit No. .....i.l.�.` a (Complete in Duplicate) Date Issued ----4---------- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Healfh District for a permit to co ruct ar��i�n all/thdescdescribed.e or i This application is made in compliance with County Ord' ante No. 44. i --------------------------------- JOB ADDRESS ANDC *- ---` Phone --------- - -- -- -- ------ . -- Owner's Name- -- Y -_-.. ------------ Address...-_.-- --- • ----- x Phone--- ------------------------------ •------------- -0 Contractor's Name--.-. -�---/------ Installation will serve: Residence tq Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ / S° ,'_x /3`-------------------------------- Number of living units: --1_! Number of be Number of baths --/---- Lot size _-�'------ ---------- Water Supply: Public system ! Community system ❑ Private ❑ Depth to Water Table _--_--- ft. pP y� y C _'6� Adoba,� Hardpan ❑ Gra,"l- . . _Sandy_Loa_m.❑,�Clay Loam ❑._Clay ❑_ Character of soil to a depth of 3 feet:rSand [� ❑ FHA/VA: Yes ❑ No Previous Application Made: Yes ❑ No R- New Construction: YesaF9_ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS. (No septic tank or cesspool permitted if pu i sewer is within 200 feet. � 1 septi Tank: {-' Distance from nearest well-- 4Distanc ,frorti foundation-_. - ------ --.Mat real- ..� � Ca acit - ------ No. of compartmenfs_-_2_.-- --- ._�Siz sC. --.-•-Liquid depth----. - P Y Distance from nearest well- (�istance from foundation_- _49 -Distance to nearest lotine.--- Disposql Field: D `" 64�Ju Number of lines------ --- --- - - ----- --Length of each line-y---�`�=°----Wodth of trench_----.- --T-,- ---- Total length--- Number of filter materIA. ...... �1 Depth of filter material_--/Ir------ 9 Seepage Pit: Distance-to_nearest welle from foundation` l$meer____Distance tonearestlot line----------------- Di _----_ ------ Number of pits--- ------- -----Lirsing material- -__--.------------ ❑ ----'--- Cesspool: Distance from nearest well-----------------Distance from foundation------------.--- --.Lining materia --- ---- gals. Depth -- --------- ---- - -- Liquid Capacity ❑ Size: Diameter----------------------------------- P Distance from nearest building - Privy: Di'stante from nearest well----- ------------------------------------------- - -------------------------------------- Distance ---- ---- ------------ ------ -- Distance to nearest lot me------------------- , - -- e <_`A . ------------------------------- Remodeling and/or repairing (describe)------------------------- ____----_. --_---.-'-• ----------------------- -----------------I--------------- ---------------------------------------------------' ----- 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 Jpaquin Local Health District. -----------(Owner and/or Contractor) (signed)- -�J -� . + Title By:-------------------------- ----- -- (Plot plan, showing size of lot, location of system ini relation to wells, buildings, etc., can be placed on reverse side), FOR DEPARTMENT USE ONLY -- ---------------- - ----------------------------------- DATE-------- -�-- - ---- --------------------------- APPLICATION ACCEPTED BY-------------------- ------- ----------------------- REVIEWED BY----------------- --------------------- ---- ---- -------------------------- DATE------ - -------- --- -------- ------------------------ DATE-------- ------- ------------------- --------...------- BUILDING PERMIT ISSUED---------------------=r------- -----)-------------------------------------- ---------•------------•--------- --------------------------I-------------- Alterations and/or recommendations:----- I ----------- ----- ------------- ------ I-- -�s------- Go ti ----- ---- ----------------------------------------- ------------------------------------- - ------��-�.�---- - ---�- - - ------------- FINAL INSPECTION :------- ----------------------------- ---------- / ) } SAN JOAQUIN LOCAL HEALTH DISTRICT 132 Sycamore Street 814 North "C" Street 130 South American Street 300 West Oak Street Tracy, California Stockton, California Lodi, California Manteca, California rs-9=2M Revised 8-'S9 F.P.Co. _