11399 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit (Complete in Duplicate) �1 Date Issued ------------ Application is hereby made to the San Joaquin Local Health District for a permit fo construct and install the work herein described. This application is made in compliance with County dinance No. 549. JOB ADDRESS AND LOC ION_.._ 7I--L_ ---------- 2 — -_6;Z ' ------- --------------------------------------------------------------------------------------------- Owner's Name_---a.�- ------- ---------• -- ------------------------------------------------------------------------------------- Phone-------------- Address "� --- - --- -- - - - ---------------`-- Contractor's Name ------ art" - ----------------------------------------------------- Phone_��-------J:-�7p Installation will serve: Residence 9L_ partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other El Number of living units: ____r__ Number of bedrooms z_._ Number of baths � Lot size - -------------------------- Water Supply: Public system R Community system [❑ Private ❑. Depth to Water Table l+ . Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe gI Hardpan ❑ Previous Application Made: Yes ❑ No & New Construction: Yes [. No ❑ FHA/VA: Yes ❑ No ❑ 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_________________Distance from foundation-------------------Material ❑ No. of compartments---------- ---------------Size_-------------------------------Liquid depth--------------- Capacity- Disposal Field: Distance from nearest well__/da--------Distance from foundation--�'®-_______.__Distance to nearest lot line._�.�_____. Number of lines------------- -—-------.-----------Length of each line----- _^---------------Width of french----Z.k 4 � Type of fitter material_-_ __a_C,__ ---------Depth of filter material,--1t---------------Total length---------3.3__.___'______C!��_,-- �.. Seepage Pit: Distance to nearest well----/,#a.........Distance from foundation___--!_(j----------Distance to nearest lot line_,f1__'____- { [ Number of pits------1_ -------------Lining material---? /V_Size: Diameter----:1.3----------Depth----AV_'1 __A_`------ Cesspool: •�� Distance from nearest well-__-____________Distance from foundation---_----------------Lining material------------------------------------- ❑ Size: Diameter--------- ------------------------Dept h----------------------------------------------------Liquid Capacity---------------------------- gals, Privy: Distance from nearest well---------------------------_---------------------Distance from nearesf building ❑ Distance to nearest lot Iine------------------------------------ --------------------------------•- ----- Remodeling and/or repairing (describe):---- ..______________________ --------------------------------- -------------------------------------•-------------------------------------a---- -----------------------------------------•----------------------------------------------------•------------------------------------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Coun+y ordinances, State laws, and rules and re lations of the San Joaquin Local H Ith District. SI ned r ( 9 )-- ----- ' -- ---------------(Owner and/or Contractor) K By:---------------------------•------------•---------- --- (Title) - /------ otpan, 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---- � �[1� DATE------/ -- 9 "" DATE BY---------------------------- --------=-------------------------- -- DATE - --- -------------------- BUILDING PERMIT ISSUED ----------------- DATE------------------------ Alterations and/or recommendations:-------------------------------------------------- --------------------)�--- - -----------Q= ----------------------------------- ------------------------------ ---------------FINAL INSP Y' -- - --RL 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 ES-9-2M . Revised ;-57 F.P,CO. 1