4721 - Laserfiche WebLink

Home Browse Search

-APPLICATION FOR SANITATION PERMIT Permit No. .__.. _.�____-- / (Complete in Duplicate) Date Issued ` Applica+ion is hereby made to the San Joaquin Local Health District for a permit to construct and install tie work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LO ATION ------ ------------------ ---------•-----. •------------ Owner s Name ---------- Phone a -------------------------------------------- Address �� ' --------- ------ ----- --•- ; --- --- ------- --------- - -- --------- Contractor's Name............ ------ Phone_ p7_ qke.7---- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _1_____ Number of bedrooms _i?�Number of bathsT_-___- Lot size __-./ ______________________ _______________________ Water Supply: Public system E] Community system ❑ Private �pth to Water Table .N?ft. Character of soil to a depth of 3 feet: ' Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam E❑ Clay ❑ Adobe 24Hardpan ❑ 4 Previous Application Made: Yes ❑ No D�New Construction. Yes ❑ No i - TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tk:, Distance from nearest well-/------------- Distance from foundation--------------------Material------------------ ____________________.-___-__.. F ❑ No. of compartments--------------------------Size--------------------------------Liquid depth------------------------- Capacity Disposal Field: Distance from nearest well_________________Distance from foundation--------------------Distance to nearest lot line------- ______ ❑ � . Number of lines-----------------------------------Length of each line-----------------------------.Width of french----------------------------------- � Type of filter material-__------.--------------Depth of filter material-----------------------Total length---------------_____---____________ Seepage Pit: Distance to nearest un tion-------�_ ' �__.Distance to nearest lot line_______________ Nu'mber of pits---------- -----------Lining material_____ _ o_�_ Size: Diameter___ _ ----------Depfh----D"'7________________ Cesspool: Distance .from nearest well_____________-"_Distance from foundation___._______________Lining material_____.____-______._________________- ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy. - Distance from nearest well------------------------------------------------- from nearest building----------.__._____________-____-_-_._._. ❑ - Distance to nearest lot line------------------------------------------------------- Remodelin and/or repairing (describe)________________________________________________ _ _____ - '4- ' R-- ' ---- --Cts---- r ---------- -------------- I -------------•-----------------------=•�•------------------------- '_ ' I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ; ordinances, State laws, nd rules and regulations of the San �paLocal Health District.(Signed)------------------ �� ----------- : - -- . . --- -- . • f�4arer and/or Contractor] By:------------- ------ --------------------------- ---------•-----------------------------------(Title)----------------------------- - - - - - -- ---------------------- I (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). L ! FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------- --------------------------- DATE--------- --S.... r,"t -- - REVIEWED BY------ ''"` {'s- r a- ,,.., ff ------------------------------------------------------ •-- ---------------------------------------------------------• DATE------ ----•- -----.._....--------------------....---------- C f BUILDING PERMIT ISSUED = - --- --------------`------------------ -------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations:------------------_:--.--------------------------------------------------------------------------------------------------------------------------- i ' -------------------------------•---------------------------------------------------------- -------- ---------------------••--•-----•---. ---••--- -------•-•••------•---------------------------------•--------------------�. ............. I --------------------------------I---------- --------------- ---------------------------------------------------------------------------------------- ---------------------------------------------------- 0, 1 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 } F E5-9-2M Revised W-2100