2422 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) V pate 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..............36�S--S------Harvel---------------------_ -------------------------------------------------------------------------------------- Owner's Name----------Francis Wtson 2-,5089 ---------------------------------------------------------------------------------------------------------- Phone ,. .. { ' - ------------------------------------------------------------ -------------- Address----5�14�---------------------------------S-----•-----------------------•-•-------------�=---------------------------------- � Contractor's Name------ -------•- ••- - --------------------------------------------------------- Phone_.-.__ -3. 5------------ Installation will serve: Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _1 ____ Number of bedrooms _2____ Number of baths __L--- Lot size ----7_5,x]._C}.0_______________________________________ Wafer Supply: Public system ❑I Community system ❑ Private ® Depth to Water Table 20.__ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ ' Adobe® Hardpan ❑ Previous Application Made: Yes K] No ❑ New Construction: Yes ® No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: f (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic.Tank: Distance from nearest well.-5-0.........Distance from foundation_____ �_____-_:Material---->;eme-at=br_J.ck__---____. ® No. of compartments------------2-----_------Sizet'ilx4!x4.............Liquid depfh-°_&31-------------Capacity...__8_Q_Q---------- Disposal Field: Distance from nearest,well___40_1--------Distance from foundation_-____E2$_____-Distance to nearest lot Eine____ -_____--- E] Number of lines_______________? ________Length of each line-----7--------------------Width of trench--------------2'_________________ Type of filter material_____rO_GX--------Depth of filter material------1.$°_________Total length_________ 5--------------------------- - .Seepage Pit: Distance to nearest well________________---- __Distance from foundation to nearest lot line_-_______-.--___ p _ Number of its----------------------Linin material-----------------------Size: Diameter-----------------------.Depth_-------------------------------_ 1 171 Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material---------___________________-_________ ❑ Size: Diameter---------------------------------------Depth--_T;-_--.:-:;;;:-----__------ -----_--- --Liquid Capacity--------........---------•--gals. i Privy: ;Distance from nearest well --_--_-__ -_______________ ____-_Distance from nearest building---__ _ ❑ Distance to nearest lot line------------------------------ �-,-`--------------....-------------------------------`---�---^-----------------------------------------•--•------ Remodeling and/or repairing (describe)- I��'1.r---- �''`� ---- ' ir-------- ...... ........ _ ."."---------------------------------- -------------------------------------------------------- ----------------------------------------------------�- --------......----------------------------------------_-------------------------------------------------------------------------------....---- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------•--------------------------------------------------- I hereby certify that I haveprepared 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. Delta ___________ ____ Owner and/or Contractor (Signed)----------- ----- t - ( / I B Perry W _rthGn � - -------------------------- Title owner-Mr . -i-------------------------------- ------------- - --- ---- - (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------- --------------------------------------------------------------- DATE 1f2REVIEWED BY-----------=---------=--------------- - - --------------------------------------------------------------- DATE-- -- � BUILDING PERMIT ISSUED----- -------------- DATE-- ------------------------------------------------- Alterafions and/or recommendafions:------- -- -------------------------------------------------------------- ----------------•---------------------'------------ ---------------------- ------- -------- ------------------------------------ ------------- - - w/ := �- = ------ ---------------------- = - M ----------------------- r -------------------------------------------------------------------------------------------------- ------------- v .. y - FINAL 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 r ES-9-2M B-51 Revised W-2100 r