3149 - Laserfiche WebLink

Home Browse Search

4� d APPLICATION FOR SANITATION PERMIT Permit No. 10-12 Z (Complete in Duplicate) / A X 7 3 z— . 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--- � ----------- f Owner's Name-------------------------•----------------- ' ----------------------------------- Phone----------------------------------- �� - ------------------ - - O ---------------------------- Address--------------- --------------_-------------- -- - --------- -- •--•------- --Q-------- - -------------- Contractors Name----------------------------------------�i---_----- -- '----- --- i Phone----• Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ X` 1 --- --------- Number of living units: __�-- Number of bedrooms __�Number of baths ________ Lot size ____- '_ ---- Water Supply: Public system Community system '❑ Private ❑ Depth to Water Table waft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobegL Hardpan ❑ Previous Application Made: Yes � No New Construction: Yes No E] 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_�0__;_Distance from fou dation__-0-r------.Material___J{ ----- /!---'----!_ No. of compartments______ -/----_______Size_ -_........Liquid depth___ ��_______Capacity._,F4_O i Disposal Field: Distance from nearest well---�4-__.Distance from foundation__ 41"'O __Distance to nearest lot line.-_-__-a.r Number of cines__________ ___________ ______Length of each line__-:_ -r,-_----.Width of trench-__ -- -��____________ - � rt Type of filter material---/__�Y___- ----Depth of filter material____!�__--__-___Total length__-_/X-Q---------------------------- Seepage ______________-----_`_Seepage Pit: Distance to nearest well_ QQ__�___�I7f ro, ion__,92�P_r.___.Distance to nearest lot line_.______-_-. +, Number of pits------/------. ---Lining at -------------------- -_- _ i : Diameter-----Z a ----__-.Depth----C*2--a------------------ R Cesspool: Distance from nearest well________________ ' nce from fo tion--------------------Liquid Capacity____..._-_._____________--_gals. �I ❑ Size: Diameter--------------------------------------Depth--------------------------- - ------------------- Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-------------------------------____._____- I ❑ Distance to nearest lot line--------------------------------------------- --------•-------------------------------------------------------------------------------------- ' f: Remodelingand/or repairing (describe):---------------------------------------------------------------------------------------------------------------- --•--------•------•-------------•---- -----------------•-------------------------------------- --------------------------..----•----------•------- ---------------•--------------------------------------------- --------------------- ----------------------------------------------------------------------------------------------------------------•------•-•----------------------------- 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-rul and regulations of the San Joaquin cal Health District. 1 --�-- a w.t�------- ------ ------Lam7n----------- (Signed) -{O /or Contractor) ------- s ---------- -------------------------------------------------- -------------Title _— -------------------- (Piot Ian show ze of [ot, location of stem in relation to wells, buildings, etc., can be pl ced on reverse side). pan, FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------------------------------- �f' ----------------------------- --------------- DATE------� � " ---5--Z---------------------- REVIEWED BY------------------------------------------------------ ------------ ---- ---- --------------------------------------- DATE------- -----V----------------------------------- - BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE---------------------------------------------------- Alterationsand/or recommendations=-- --------------------------------- - --------z------------------------ ------------------------------------------------------------------------------------- ------------------------- ---------------------------- ------------------------------------------------------- ------------------------------- - - ----------------------- ------------------------------------------------- � � � FINAL INSPECTION BY: = - Date---- ----- -- -"` --- SAN JOAQUIN LOCAL HEALTH DISTRICT l30 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 8-51 Revised W-2100