10201 - Laserfiche WebLink

Home Browse Search

A _ � �6 /APPLICATION SANITATION PERMIT � . Permit No. __l____O__________!. (Complete in Duplicate) r Da J Y to Issued fU J / ys� Application is hereby made to thL San Joaquin Local Health District for a permit to construct iana install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LO f � TION --_-- ------ _ Q Owner`sName------------------ Addres------ -- ---- ----- Phone---.- Contractor's Name_ ' .� �( Phone. _ L' Installation will serve Re ence ❑ 1 partment House ❑ ommercial ail r Court Mo el ❑ Other Number of I -________ Number of bedrooms -------- Number of bathsss3e�r._[1____._- lk -- -- -- ---------------- Water Supply: Public system.�ommunity system [:] Private E] Depth to Weser Tabli .____ ft. F Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam I]+ Clay:Loam � Clay ❑ Adobe 2_,T�ardpan ❑ Previous Application Made: Yeses No , — ! pp ❑ �New Construction- Yes �o ❑ `FHA/VA: Yes ❑ No ❑ N l 1 I TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted of public sewer is available within 200 feet.) r I Septic T nk: Distance from nearest well___ 1 -5izeance fro�ffo_un gjion__-`0__ "aMaterial______ --_ ____________ 1 No. of compartmen's-------Z--- �-- --- -----Liqur depth---------//-------------Capacity-•- ---- Disposal Field: Distance from nearest well..7)14vk---Mstance from foundation. _ _ _ k _ i tante to nearest lot line----S._____._ Number of lines-_ - `' i+ ' rLen'th of each line_- �A __ 41; d ench..___,z ___. --------- -- -__s9 Type or filter material.____,______.__Depth-'of#filter materia l____ ______._._-Total length-------f3r-__-- --[,___ --- Z Seepage Pit: Distance to,nearest well.. �hS1,___Distance froth ;4t ation_"'_'u�________..Dista e:t�o nearest lot fine____ J_•,_ Number of pits- ------------_Lining•material___ iameter____ Depth---- Cesspool: - 1 - ��---- - Depth-- - -'"- - Cesspool: Distance from nearest well:----------------Distance from foundation_______ _----.Lining material-_-__"`�_____________----------- 1771 __ ____ ❑ Size: Diameter -Depth-------------------------- 1=; #-----Liquid Capacity- ---------------------gals. Privy: Distance from nearest wefll_. __-________________________________________Distance from nearest building __ ❑ Distance to nearestflot line ----------------------------------------------------- " g t ----------------------------•-•-----------------------------------=(-------pp------------------------- Remodeling :_----"------ Remodeling and/or repairing (describe):---------- ------------------------------------------- i 1 ----------------- -- 1 ----------------- ------ ------- ---------------------- --------------------------------------`----------- - ' 1 , ! 1 j . t a a i _ W ------------------------ ------ ----"--------------- 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. 5i nedE . � whet and/or Con t ----------=------------------------------------------------- ----•-----------------------------" .(OContractor) �y�---- - ,- F- -- -` -- - ---- ------------------ ---------- - - ----------------------------------- - (Title)-------------------------=�--------------- ---- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). i . 1 � FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- ' ,--7--------------------------------------- --DATE-- __5 REVIEWED BYi --------{-----------------------------------------------------------------------------------DATE------------------•-------------------------------------- BUILDING PERMIT ISSUED-------------------------------------------------------------------- -------------------------------- DATE I Alterationsand/or recommendations:----i--------------------------------------------------------------------------------------------------------------• ----------------------- -------- ------------ -----------------•---- --- - -- •- '`, ----------d------�-- c--�-.�.,_�.�C-- ----------- ------------------ --=--- ------------------------------------------- - ---- -------------- ----------------------------------------------------------------------------------------------------------- -------- F1 NAL INSPECTION BY:. - �Date`� - ��' ' SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Reviseo 1.57 F.P.CO.