9410 - Laserfiche WebLink

Home Browse Search

1ry17 � APPi_ICATiON FOR SANITATION PERMIT Permit;No. .-,��l----____ (Complefe in Duplicate) 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 ATION..- ---•moi,--- '� ---------- Owner's Name-----'----. - ----- --------- -- - - -------------------------------------- ------------------------------------ -- -- -- - Phone------------ ----------------- Address---- ----------------Address----------------- -------- ------------------------ --------------------------------------------P--•--•-------- ---------- ------------------••----------------------------.. ------ Contractor's Name--------------------- ------ ------- ----- Phone. i Installation will serve: Residence �artment House ❑ Commercial ❑ Trailer Court ❑ Mofel ❑ Other ❑ Number of living units: __�_ Number of bedrooms __ Number of baths __l__ Lot size _______________________-_______________-.--__________..____ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table ft. Character of soil to a depth of 3'feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Iardpan ❑ 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.) eptic ink: Distance from nearest well-_______________Distance from foundation--------------------Material------------------ -----------------____..,_____- No. of compartments------------- ------ ----Size--------------------------------Liquid depth--------------------------Capacity_____------------------ Disposal field: Distance from nearest well----.-------- --.Distance from foundation________.________Distance fo nearest lot lin`!______________ Number of lines---------/___ ___________Length of each line_____6_0_- ----------- Width of trench------s�-_�___ ______________ Type of filter material '_��Depth of filter materia l____ _ �______Total length______y`~�__`_________________. I Se a e Pit: Distance to nearest well___._= _._______Distance from fou ation____________________Dis�tance to nearest lot line-- It Size: Diameter__ ��_ Linin material a7+, g•� Number of pits------�---------- 9 � - -------- ------,Depth' -�=-----�: Cess ool: Distance from nearest well-----------------Distance from foundation_________.____.__.`.Lining material-------------.----------------------- . ❑ Size: Diameter Depth----`------------------------ ---------------------Liquid Capacity--------------------- ------gals. _ i Privy: Distance from nearest well----------------------------------------------- _Distance from nearest buildin 9 ❑ �--- Qistance to nearest lot line----------------------- = Remodeling.and/or repairing (describe):---- :.-- �Q -� ---------------------------•--------------•-------• . -----••------------------------------------------------------------------------ _-------------------------- -; --------------------------------------------------------------------•------•------•------------------- r,. I hereby certify that l have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, a d rules and regul lions of the San Joaquin Local Health District. Si ned) -- r------------- Contract ( 9 _ Title 4., BY: (• ) '------------- (Plot plan, showing size of lot, [ ion of system in relation to wells, buildings, etc., can,be placed on reverse fide). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------------- --------------------------- ----- ------------------------- ------ DATE------------------- -�:?� ---------- REVIEWEDBY-------------------------------------------- --------------------------------t ---------------------------------------- DATE------ ------- BUILDINGPERMIT ISSUED----------------------------------------------------------------=------------------------------------ DATE } Alterations and/or recommendations:__.__________________ _ - - - --------- - •- - ------- Y 1z=r s W �. - ----- - ------------------------------------------------- - ------ -------------------------------------------------- ------------------------------------------------ -- ---- ------------- ---------- ---------------------------------- ------------------------- - ------------------------------------------- FINAL -------- - FINAL INSPECTION BY---------------- ----• --;-- Date . SAN JOAQUIN.LOCAL HEALTH DISTRICT 130 South American Street 300 Was+OakStreet " ' • 4- 132 Sycamore Sfr et . _,a 814 North "C" Street x Stockfon, California Lodi, California Manteca, California' Tracy, California ES-9-2M , Revised 1.57 F.P.CO.