10565 - Laserfiche WebLink

Home Browse Search

� APPLICATION EOR SANITATION PERMIT / fermi#-No. _fly-�.�!-•S 'Q (Complete in Duplicate) 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. JOB ADDRESS AND LOCATION___ !_____ :-- --- Owner's Name----------- Address - --- - ------ -------- --- ---------•-------------•-------------------------------------- Phone ------- Contractor's Name ----------- Phone ------------------ Installation will serve: Residence Pq`Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other El Number of living units: Number of bedrooms _A-- Number of baths _- Lot size _ i ----------------- 4 Water Supply: Public system [Community system ❑ Private ❑ Depth to Water Table o- ft. Character of soil to a depth of 3 feet: Sand [] Gravel (] Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeRa—'FTardpan ❑ Previous Application Made: Yes E] No [ New Construction: Yes ❑ No [�t' FHA/VA: Yes ❑ Nom. TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or`cesspool permitted if public sewer is available within 200 feet.) ?A�ep�ficank: Distance from nearest well________________Distance from foundation___________________.Material-__"__________.__-_____._--------_-"--___No. of compartments--- ----_- ----Size--"---------• ----------------•-Liquid depth------ - --- - ---- - Capacityy�J ------- -------- pos I field: Distance from nearest well"_X"Z1 bistance from foundation____If Distance to nearest lot line-_447/_-".-_- Number of lines...-.__-/� _-Length of each line____-- `___ �� g --e -- Width of trench ---•--------------- f Type of {filter material- ---:_Depth of filter material____ .............- Total length_______ , -"-------------"_-_•- Seepage Pit: Distance to nearest well_______`- Distance fr m fo dation___-1l!____:__.Di to ce to nearest lot line____________ [ Number of pits_-'--- ------------Lining material--� �-Size: Diameter----- ----- ---,Depth---- ------------------- Cesspool: Distance from nearest well __Distance from foundation____________________Lining material------------------------------------- El Size: Diameter---{---------------------- ------------Depth------------------------------------------- Liquid Capacity------------------- gals. Privy: Distance from nearest well_--_------"_______ ---___-_Distance from nearest building 1 -------------------- ------------------------------- - ----------- Distance to nearest lot line__________________"____________._____ Remodeling and/or repairing (describe)_________________"__- "- �� „(�, � f -------------- ------------------------------------------------------- -11----------------- ---------------—--------------------------------------I--------------.---Pp-----------------------------------:---------- ---------------------------------------------------------------------------------------- I -- y herebycertifythat I have re ared this application and that the work will be done in accordance with San Joaquin Count ordinances, State laws, and rul and re ulatfiQns of the San Joaquin Local Health District. (Signed) --------- b ------ ---- ---- -- ------------------------------------------------ By:-------------------------------------------- I---------------- ------- (Tit [F '�� '�— ontract or) le)_ . (Piot plan, showing size of let, location of sy m in.relation to wells, buildings, etc., can be placed on reverse side). a FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- --- -------------------------------------------------- - -----•---------------------------- DATE------------- Gf , REVIEWEDBY------------------------------------------ - - ----------------- --------- -- -- ----------------------------- DATE-------------- --- BUILDING PERMIT ISSUED ------------ ----------------- - SSUED - ---------------------------------- DATE------------ 'Alterations and/or recommendations:----------------------------- ---------- -------Y ------- -------- -------•-------------------------------------------- ------r------------------_------------- •--------• ;� -- --- -- --- -- ----------------------------------------------- FINAL.°.'INSPECTION BY: P-1 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 Revised 1,57 F.P,CO.