3479 - Laserfiche WebLink

Home Browse Search

C APPLICATION FOR SANITATION PERMIT Permit No. _3--"_7------ ` D [Complete 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 Ordi ante No. 549• JOB ADDRESS D LOCATION _ � ----- ---- Owner's Nam f �r ------------------------------- Phone 7_ Address- ----- - - ------------- Contractor's Name---------- ......•,........... -_--------------------------------------------------------------------------------------------------------- Phone ----•-------------------•- Installation will serve: Residence Apartment House j Commercial ❑ Trailer Court ❑ Mof KI Other ❑i Number of living units: _-1-- umber of bedrooms --1----- Number of baths -L--.__ Lot size __ __ ''_. __:- -_----_-_ • ----- Water Supply: Public system Community systehs-❑ Private ❑ Depth to Water Table ---._-- ft, Character of soil to a depth of 3 feet: S7NIew Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe [Hardpan ❑ Previous Application Made: Yes ❑ No Construction: Yes VNNo ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted ' ublic s r is available within 200 feet.) ? Septic enk: Distance from nearest wel :� Esta ce fro �foun $on _ _I/_.__--Mafier al- ------------ - ---- ---- - No. of compartments ize -. --Liquid de�th Capac�tY � A-1 Dispos�i Field: Distance from nearest we11l_- i istance from foundation- --_-d..---.....Distance to nearest lot ine -��--_- �/ Number of lines ------ ( ------- ------- ength of each line--------_ - -- _-�_-_-Width of trench.- __---- ---------- Type of filter mater' ��'_ _,epth of filter material--------/-. --------Total length------ - I Seepage Pit: Distance to nearest well----------------------Distance from foundation------------------- Distance to nearest lot dine-_---.-.---_-.. ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-------------- --------DepA -------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation.-.--------- --.Lining material-___--_-------_ ------ ------ ------ ❑ Size: Diameter Depth ------------------------------Liquid Capacity---------------------------gals. Privy: Distance from nearest well---.-------------------------------------------------- Distance from nearest building------------------_-----.- ------- Distance to nearest lot line___._..____--.--__ -------- ' Remodeling and/or repairing (describe):-------------------------------------------------- ------------------------------------------------------•-----------•-------------------------------------•----------------------------------- --- ------------------------------ hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)... .-ate ------------------------- ------------------------------------------------ (Owner and/or Contractor) .r= . By:---------------------------------•---------------------------------------- ---------------------------------------------------- Title of plan, 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-- -------- __ DATE. ' ---- REVIEWED BY --- --------- ---------------------------------------------------------------------- ---------- DATE---- ---- BUILDING PERMIT ISSUED------ ----------------------------- -------------- - --------•-------------------•--- DATE-----�'.'�. Alterations and/or YI 2 SS 1 r ommendat ns:- -------------------------------- - ------- ------- --------._------te--r---/- --------•--•----- T' --------------ra -------------- -------------- ------ ---------- __----------- = S ----- nlv---.K.{ / E' 1.�e A- ----------- ------------------------ c; -- FINAL INSPECTION BY ' ---------- Date---------------7f ` 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 ti ES-9-2M 10-52 Revised W-2100 x