9090 - Laserfiche WebLink

Home Browse Search

r' APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) ° ..,r . .. Date 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. I JOB ADDRESS AND CAT ;-- Owner's Name_______ ---- ------------------ Phone. --------------------- Phone - " Contractor's Name----- -- f �L! --- - --------- -------------• Phone_..__. - -- ------------- Installation will serve: Residence k-e-A"partment House.E] Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ !dumber of living units: Z___ Number.of bedrooms Number of baths Lot size _,-307- _l21.0_____-__-_- _ Water Supply: Public system Community'system ❑ Private ❑ 'Depth fo Water Table 'f+. -, Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [q-11—ardpan ❑ i1 Previous Application Made: Yes ❑ 'No New Construction: Yes ❑ No 'THA/VA: Yes ❑ No 1 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) ! Septic Ta;r k: Distance from nearest w (_ Distance from foundation__-1,9---------I\Aaf No, of compartments--- -----------------Sizeelt _ _ _:-°_Liquid depth---�------------ Capacity___-- �g„�- --- Q _ _ Disposal Field: Distance from-nearest well - stance from foundation___- __ ` r --______-Distance to nearest lot fn9�_ ----••_-- Number of.lines--------- ---- ----------- Length of each line_-o�-_----------------Width of ---------------__-_-- Type of filter material-z��Depth of filter materiaf___114?`e'l------Total len th-__._ ` g �-2P---------------�------ Seepa e P'ti Distance to_nearest well____ istance fr m oun anon_____ ___ g� — �� .De to nearest lot lin ! Number of pits---/__-____---__Lining material! ___��ize Diameters,?-//-_-___-.De th---__ ._ __________________ 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----------------------------- -------------------------- ------ 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, anj rules and -regulations of the San Joaquin Local Health District. (Signed}-- `�Qwne*�r- M ______________ - _ � � .° 5 Contractor) 2 BY:------- ------------------------- = ---------- : r Title ( ) -------- (Plot plan, showing size of lot, locati of system in relation to wells, buildings, e+c., can be place on reverse de). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY __ DATE REVIEWEDBY-------------------------------------'---------------- - - --------------- ------- DATE--- j= --------------------------------------- PERMIT ISSUED- = DATE---- ----------------------------------------------------- - •----------------------•----------- � ,. I Alterations and/or recommendations:__________ -------------------------------------------------------------- I--------- - --------------------------------------------------------••-•------------ -------------------------------- ------------------------------- ------ ---------- -------------------- ---------- - 7 --- ------------------- - , 7, �--`S FINAL INSPECTION-$Y:__v ------ ----- ---- --- =-------_---=-- Date-------------- -= SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 30; West Oak Street r 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California f ES-9-2M . Revised 1-57 F_P.CO.