2446 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. t' (Complete in Duplicate) a � -Y 5" 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 r ----------------------------------------•-------------------------------- Owner's Name------ -----------------------------------! ----- Phone---------__----------------------- v /� Address------_-------------- ------ --- - ---------- �4-�"�- ' --------------------------------------------------------------------------------------- ------ ---------- Contractor's Name--------7 r?_z L---------------------------- --------------- Phone_.-------------- °------------- Installation will serve: Residence �g Apartment House ❑ Commercial ❑ Trailer Court [❑ ,Motel [j Other E]Number of living units: .___ Number of bedrooms __ - Number of baths _/___ Lot size __C�d__X-_IIJ1------------------------------ Water Supply: Public system �. Community system -El Private El Depth to Water Table -------- ft. f Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ElClay Loam E] Clay ❑ Adobe Hardpan Previous Application Made: Yes ❑ No �( New Construction: Yes A No 0 TYPE OF INSTALLATION AND SPECIFICATIONS: f (No septic tank or cesspool permitted if public sewer is available within 200 feet.) � ----------- - _Septic Tank: Distance from nearest welli�d_______Distance from foundation_l6 .Maferial_�r� ► No. of compartments---------� ___ _______Size_ _ _Y_ ' _______Liquid depth_- _.?A -_______Capacity__:_ Disposal Field. Distance from nearest weli__�__--------Distance from foundation------ ----------Distance to nearest lot line-24-- ----- i Number of lines----------- Length of eachline, p" b:iWidth of french-------9 4---_`_--------------- Type of filter matenaL_ _______Depth of filter material---��______________Total length_:___L;�n_o__________________--__-_ t Seepage Pit: Distance to nearest well----------------------Distance from foundation---------------_----Distance to nearest lot line__-______________ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter------------------------Depth---------------------------:----- f Cesspool: Distance from nearest well---------- ------Distance from foundation--------------------Lining material-___________________________________- ❑ Size: Diameter---------------------------- - ---Depth--------------------------------------------------.-Liquid Capacity----------------------------gals. Privy- Distance from nearest we]------- ------------ ---------Distance from nearest buildingi' ❑ Distance to nearest lot line------------------------------------------------------------------------------------------------------------------------------------------ 4 Remodeling and/or repairing (describe)----------------------------------------- --------------------------------------------------------------- --•-------•---•---------------------------------------------------------------------------------- 1 --------------- -•-----I-------------------------------------------------------------------------------------------------------------- _______________________________________________________________________________________________________________._-_____-._--_______.-_-__________--_______-_________________-________--____-.__--.----.-___-__.---.----_-__-_.- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County I' ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. -� = I (Signed)-- Owner and/or Contractor 9 } ----- ------------------------------------------------------------------------------------------------(Title----------------- ------------------------------------------- (Plot ----------------------- � BY�------------------------------ =------- -------- Title}--------------- I� (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). r - FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- ----------------------------- DATE------------------ ------------- REVIEWED BY-------------------------------------- =7 - - DATE---- =e - - ------------------ BUILDING PERMIT ISSUED----------------------- ----------------------------- DATE---------------•----- ------ --------------------------------------- Alterations and/or'recommendations-------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------- ----------------------------------------- ---------------------------------------------------------------------------------------•------------------- = F --------------- ----- --------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------•- M ______________________________________________________________________________________________________________________________________________ ________________________________________________________________________ 3 --------------------------------------------------------------_------------------------------_------------------_____________________________________________________________________________________________________________ i 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 ES-9-2M 8-51 Revised W-2100