7745 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. - .�--4�....�... r SSP (Complete in Duplicate) _ Date Issued -------------------- A"plica,{ion is herebymade to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is mde in compliance with County Ordnance No. 549. z I �� JOB ADDRESS AND LOCATIO _____� �--��-- �/_ --- ----••-------"""""""- 1�11 ------ ---------------- ' Phone----- --------------- --------- � .._.. _ Owners Name--------------•-•- - ... Phone.-_-_ -•------------------- •----------r - Address------------ - - -. --- -------Contractor's me_ - . Installation will serve- esidence partment House ❑ ommercial ❑ Trailer Court �1/❑ Other ❑ Number of living units: __l___- Number of bedrooms :�5--- Number of baths __-/-- Lot siz .__ ---"----------------------------- Water Supply: Public system ommunity system ❑ Private ❑ Depth to Water Table ------"- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[a--Hardpan ❑ Previous Application-Made: Yes [t�o ❑ New Construction: Yes [2,-046❑ TYPE OF INSTALLATION AND SPECIFICATIONS: s (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearesfi P144-Distance from foundation-----1-i------ .Materi a--/-/---------%------------- ! - No. of compartments---- --?� ---Size-----�FX 4-?/Liquid deptli_------- Q Capacity ` s Disposal Field: Distance from nearest well_��_�Distance from foundation____��-::_.Distance to nearest lot line---- 1_ ______. � ' Number of lines____________ ' --------- Length of each line___`'-_ :.-.Width of trench______.� -__.____.------"_--- �� F--Total length-----•----7-_< of filter material__--5 __Vk_._%Depth of filter material_-__._1_ _-__r"_- Seepage Pit: Distance to nearest well.__4--. e--_-Distance from foundation-_- ___..___.Distance to nearest lot line_ _ _Number of pits.__.___._.--------Lining .mateSize:•Diameter-------- s .�.........Depth----- --------------- Cesspool: Distance from nearest well pistance from foundation--_._.__._"_______-Lining material------------------------------------- - ❑ Size: Diameter------ --------------------------- _Depth--------------------------------------------- -----Liquid Capacity----------------------------gals. Privy: Distance from nearest well--------------------------- ------="----------Distance from nearest building------------------------_--------------- Distance to nearest lot line-------- -------- ---------------------------------------------=----7---------------------------- --------- Remodeling and/or repairing (describe)--------------------- ----•------•-------•"-------------------------•--------------=------•-„/'". -•-------------------------- "---..-----•-- ----------------------------------------------------------- i I "-------------"-----------••------•------------•-------------------------------•-"---------------------- ---------•-------------------- p ------ ---------------------..------ -----------------------------••-•----------------••-----------:----•------••-------•---------------------------------•-------------- 1 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 re ulations of the San Joaquin Local Health District. DAV & NIGHT (Signed).. Septic Tank Service caner and/or Contractor) 12b6 50. Eldorado ti0 2-7046crT' } By •-•-------- -•------Stocktoas,-Cali# ----- itle �C - (Plot plan, showing size of lot, location of system in relation to wells, b dings, etc., can be placed on reverse side]., w 6 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------------------- DATE____._.-__ ____ --�:-- -- �' REVIEWED BY------------------ -_�.- - DATE - `` c BUILDING PERMIT ISSUED -----------------•------- - DATE- --'_:-.. -- Alterations and/or recommendations:--- ---------- - ----,-------------------------------- -------= --- ----- -------------•------------------------------------------------------------------------------------------------------- �--- -- ------------------- i_ __ i ---------- --------------------------------------- FINAL INSPECTION BY- --- -•- ---- ---------------------------------- Date------------ -=--------- •-------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 Horth "C" Street S}oak+ort, California Lodi, California Manteca, California Tracy, California E 4I•9-2M I45446 AYWnOa 52-54 k