10184 - Laserfiche WebLink

Home Browse Search

a, APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) j� .� bate Issued 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 compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION--- 2------------2-030-30----Uli_ve---------------------------------------------------------------------- ---------------------------------- Owner's Name--- D-a.j_a_.D.__DraPex------------------------------------------------------------------ ------------------------------------------- Phone-- --------------------------------- Address_.... ------------------ SjEjffie -------------------------------- Address-----------------------SjEjffie = Contractor's Name------ -------- IKE'i,S --- SEPTIC --- TANK -SERVICE ---- ----------------------------------------------- I ---------------- Phone__H0_-45— 2-? i------------- Installation will serve: Residences Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: 1_____ Number of bedrooms __2--- Number of baths --- 1- Lot size __75_X__326__Xt________________________________ Water Supply: Public system :K) Community system ❑ Private ❑ Depth to Water Table35__-_- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes No ❑ FHA/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________________________________________________ ❑ No. of compartments ----- --------------------- Size -------------------------------- Liquid depth__------------------ --- Capacity Disposal Field: Distance from nearest welwj_ ~.-_.Distance from foundation____d,5--- ftr --- Distance to nearest lot line__5.-t---_-___ XBEj Number of lines--- -1 ---------------------------- of each line__ )__ft ----------------Width of trench ---24-- jn-------------------- Type of filter matSumerial_____-------rQ!*---Depth of filter material-_1$__iL1.______Total length ------- Distance to neare t _ _ _ well__ - Distance from foundation __$0---__ftt-___.Distance to nearest lot kne5ft_________ ❑x Number of pits-__-- ---------------- Lining material---rack----------Size: Diameter ------ 4X7_f-----. Depth ------ 7 -;ft---:-----------_. Cesspool: Distance from nearest well ----------------- Distance from foundation -------------------- Lining material __._______--- ------________________- ❑ Size: Diameter ------------------------- ------------- Depth ------------------------------------- --------------Liquid Capacity ---------------------------- gals. Privy.- Distance from nearest well --------------------------- _--------------------- Distance from nearest building _-------____________________-----------. ❑ Distance to nearest lot line ------J----------------------------------------------------------------- ---------------------------- ---------------------------------------- Remodeling and/or repairing (describe) _K'`-'"---------------------------------------•------------------- ------------------- ------------ I --------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------- ----------------------------------------------•------------- --- 11__••-------- --------------------------------------------------------------I------------------------------------------------------------------------- ---------------------------------•-------•---------------------------------------- I hereby certify that I have prel ared this application and that the work wilis6e done in accordance with San Joaquin County inaces, State laws, and rules and iregulations of the San Jqaquin tical Health District. ordinances, (Signed) ------------------- (Owner and/or Contractor) By: (Title) ---- (Piot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY � V1 -'F r APPLICATION ACCEPTED BY--- ---------------------------------- . I ------------------ Q -__--------- DATE--------------------------- ------------------------- -------------------- REVIEWED BY--------------- ------------ ----------------------- ------------------------------------------ DATE ---cam-------------- ---------------- BUILDING PERMIT ISSUED ------------------ ------------------------------------- ---------------------------------------- DATE-------- Q.^ AIeratia s and/or r commentio :-'�- ------------------------------ -----_ = ---------- -------------------------- ---------------- 6if M4 Al FINAL INSPECTION BY: -----•------ Date------ -- �5~- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street ii 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California 1 Lodi, California Manteca, California Tracy, California ES -9-2M . Revised 1-57 F.P.00.