10476 - Laserfiche WebLink

Home Browse Search

�A APPLICATION FCR SANITATION PERMIT- Permit No. (Complete in Duplicate) Date Issued -----------— Application is hereby made to the San Joaquin Local Health Dist ricf for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND ,WCATI ------- --------------------------------- T1 4 -- --------------------------- --------- --------- -----.-- Phone,.*W---- Owner's Name----------- -------- --- - ------------- --- ---------------------------------------------------------I.,-------- Address....----------------- ------- ---- &?,------- ---------------- ---------------- a Name---- . 7�;__ ` ! -1-14, -- - ------------------------------------- Phone 2?1v_.&r—?"7 Installation will serve- Residence g�partment House E] Commercial E] Trailer Court [] Motel E] Other E] Number of living units: --/-- Number of bedrooms -a--- Number of baths J--- Lot size ----- - ______________________ Wafer Supply: Public system Community system El Private F-1 Depth to Water Tabl,,?47ft. Character of soil to a depth of 3 feet: Sand 0 Gravel E] Sandy Loam E] Clay Loam El Clay E] Adobe [Hardpan 11 Previous Application Made: Yes E] No T--"'New Construction: Yes F] No UFHA/VA. Yes E] No 0 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if �jublic sewer is available within 200 feet.) Septic T nk: Distance from nearest we4lb_- ---------Distance from founclation-_/e-----------M a f e r i a I-- No. of compartments------- ;.2 ----------Si.,__��Y2_6--------Liquid cIepth______-5_/A�t--------Capacity- 200.- DisposalField- Distance from nearest well Distance from fcundation_49ZD_"-----Distance to nearest lot lins,_�� Number of lines--!----- Length of each ...........V_-Width of trench_-__ ___________________ Type of filter material 5 _ __Depth of filter material--- _________Total length---------�?a_----------------------- Distance to nearest is ance ,wm Seepage st well - ---------D' t f Tf _/A4Le_.'__.Disfance to nearest lot line--- ____.._ eundafion ------ .4 Number of pits------/------------Lining material- - -----Size: Diameter--9c Depth.,a2- ------------------------ Cesspool: Distance from nearest well-----------------Distance from fo undation------------------- Lining material__.___.-----________._____.________-. ❑ Size: aterial ----------------------------------- Size: Diameter------ ----------- -------------------Depf h--------------------------------------------------.-Liqu;d Capacity------------- ------ ------gals. Privy: Distance from. nearest well--.---------------------------------------------Distance from nearest building.-_-:-----------------.-___----________._. : " ❑ Distance uilding----:------------------------------------- Distanceto nearest lot line--------------------------------------------- - -----------------------I--------:-------------------------------------------------------------- Remodeling and/or reeairing (describe):---- -------Z&;�4�._ ---------- ---- -- ----------- - _ -- W ------------------------------------------------------------------------------------------- -------------- ---------------------------------------------------- ------- -------- ---- ----- ------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------- -----------------------------------------I------------------------------------------------------------------------------------------------------------------------------------------------- --- - I hereby certify that I have prepared this application and that the work will'be done in accordance with San Joaquin County ordinances, St laws, and ru nd reeulati ns of the S Joa in Local Health District. (Signed)----------- - -- ----- --- ------- ---- -------- ---- ---------- -------------------------------------------- wner,and/or Contractor) By:--------------- ----- - - - ------- ---------------- {Title i ----------------------------------------- (Plot plan, showing size o lot, location of system in r a on to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- Y---- ---------_ - ----- -- -- ------------------------------- DATE----- -------;,i------ -- ------------ ---- -------------------------- --------------- --------S--- ---------------- REVIEWED BY------------------------------------- --- --- -- -- - ------------------------- DATE----- ------------- - ------------- DATE------------------------------------------------------------- ------- --------------- ------------ BUILDING PERMIT ISSUED._--------------- --------- --- ----- Alterationsand/or recommendations:_-___-______________ --------------------------- _--------------------------------jr---------------------_- ...... ----------------------------------- ---------------------------------------------------------------------------------- ---------z----------------------------------------------I/------------------------------------------------------------------------- ---------- ---------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------- ---------------------- ------- --------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------ I ------------------------------------------------------------------------- ...... ---------------------------------------------------------------------------------------------------------------------------------------- FINAL INSPECTION BY:__: ----- ------- ---- ---- Date..../------/,,�7 --------------------------- - - - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street e 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California -Manteca, California Tracy, California ES-9-2M Reviso6 1-57 F.P.CO.