2023 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit N - (Complete in Duplicate) Application is hereb q Date Issued 1 �3 � y made to the San Joa uin Local Health District for a permit to canstruct and install the work her / > This application is made in compliance with County Ordinance No. 549, JOB ADDRESS AND L described. ATl N-__ - Owner's Name_.-•--___-- ,� 11 _. __- - '�t- - - Address-- ----_t�,.v -- ---- - ------ -� __ _.____-__•_ ---------------------Contractor's Name. - --------------------- Installation will serve: Residence -------------------- ----- Phone._._ ❑ Apartment House -____._ --_-__----- , Number of living units: ❑ Commercial ❑ Trailer Court ❑ Mote! ' - Number of bedrooms .______.. Q- Other ', Water Supply: Public system Number of baths _�ot size __-_- Y e Community system ----- -a-V- �_- Character of soil to a depth of 3 feet: Sand Private - --------------- ❑ Depth to Water Table _�_�-- Previous Application Made: Yes [] No � Gravel � Sandy Loam � Clay Loam E] Clay New Construction: Yes R-_=0 y ElAdobe�'�+dpan ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: o (No septic tank or cesspool permitted if public sewer is available Se tic Tank: within 200 feet.) y Distance from nearest we11_ - -- Distance from fou No. of compartments-- lion----j�Q---------Mat ,rial------ ------------ --------- ' f5ize_ - c__ 417. Disposal Field: Distance from nearest welt- Liquid de�th___--_- `` - ----------Capacit�-_._ __<.Distance from foundation _- _- -- '�� j' Number of lines_______ Length of each line____ Distance to neares}�lot line-__-- Type of filter material____ ---r-L - � ----------Width of trench______ " ---Depth of filter material------ --- -« �� See a e Pit: � -- - Tota l length Elp g Distance to nearest well--------------------- Distance from foundation.__ ---------- Number of pits--------- Lining material----------------------- Distance to nearest lot line-__•___--•_•_--__ Cesspool: Size: Diameter--------------------------------- ---- .Depth--------------------------------- El ----------- ----------------- Distance from nearest well_________________Distance from foundation_-______--_-------.Lining material_____--____-_--- Size: Diameter---.. est---------------------- -----------Depth------------------------------------ ----- ------ - -----'---------- Privy: Distance from nearest well-------------- Liquid Capacity___------------ ----------- ----------------------- gals. Distance from nearest building Distance to nearest lot line9 .° Remodeling,and,/or repairing (describe)l:_ ---------------------------- ____________----------- ____---___� 'c ---------�''z,e-- - ------------------------------------•___•___•___-__•__-_•. x-'r__•_____•_`_ -,.__.T.._ __•___f----------------•----'----•------•-------•------------------------- ___________________---------------------------------------------------- ______________________________________.-_-___-___-__-_-_-____-___-_________-________-__-____-___---_____________._-__-___-_-__.__--_•-_-___--_________ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joa urn ordinances, State s, and rules and regulafro s of the San Joaquin Local Health District, f,� q County (Signed) er Contracc� (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). - ------------- - ----------------------------(Title)-------------------------- FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY__-- 6---------------------------------------- _________________________________________ REVIEWED BY----------------- ------ ------ -- DATE---- --- --�-------j--- - - ----- - ----------- - 1 ---,-------------- UILDING PERMIT ISSUED------------------------•-- --------------------------- ---------------------- DATE------- ------------------------------- - ----------- ----eratians and/or recommendations:-- ----- - --------- ------ - ----•---.---------- ----- ----- ------ - DATE-- ------------ ---------------------------------------------------- ------------ � ------------------------------------- FINAL INSPECTION BY:---- v --V .------------------------------------------------------------------------ Date --- _- ------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street Stockton, California 132 Sycamore Street 814 North "C" Street f_odi, California Manteca, California - Tracy, California ES-9-2M 8-51 Revised W-2100