6269 - Laserfiche WebLink

Home Browse Search

Qq APPLICATION FOR SANITATION PERMIT Permit No. ..h..2G_I.... (Complete in Duplicate), Date Issued Applica+ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein d scribed. -J This application is made.in compliance with'17 County Ordinance No. 549. 1 ow,�p�j 25" .,�.• Co P.C°.4-[_ H owo'tn�� 1 . JOB ADDRESS AND LOCATIO - si�----------------------------------- ----------------- Owner's Name = ---- ------- - ------------- ---- Phone Address--_... ---- - --- --: G ° Contractor's Name ------------------ Phone.---------------------------------- Installation will serve: Residence �A arfinent House ❑ Commercial ❑ Trailer Court ❑ Y4 tel [j Other ❑ Number of living units: ___t__ Number of bedrooms _- Number of baths ---(__. Lot size ___-__ ._. Water Supply: Public system ❑ Community system El Priv Depth to Water Table ft. Character of soil to a depth of 3 feet: '.Sand ❑ GravelX Sandy Loam &� Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ Nok New Construction: Yes'06 No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: _ (No septic tank or cesspool permitted if public sewer is available w Sep -cI Tank: Distance from nearest well___ Distance from oithin 200 feet.) and tion Materia ------='------------- - ! _ ----------- LA }} No. of compartm -Liquid de th____;__.-___ " .__._.�Size-_ _____._Ca aciY..� f_ Disposal Field: Distance from nearest well.--- - A--.-Distance from foundation_ _ i _____.Distance to nearest lot line___ r Number of lines--------/_______�_________�___/__Length of each line---?10--..___--_-- --.Width of trench. __ r Type of filter material l_XO epth of filter material-----C940- Total length____ �__________________________ r Seepage Pit: Distance to nearest well__________________---Distance from foundation--------------------Distance to nearest lot line__--_--.________- ❑ Number of pits---------------------Lining material-----------------------Size: Diameter-----------------------Depth---------------------------, ---- Cesspool: Distance from nearest well--------------_Distance from foundation---_____--__.-_.___.Lining materia!__.___-______ ._______-____i________ of Size: Diameter------------------ -------------------Depth------------------------------------ ---------------Liquid Ca acitY-- - f:.� ..❑:; ._._ --,..: � ��a^.M' - T i .Qw- - ,:- .-__ .� -... -•: ----Lam-•--�.e. y.__. .. _ a : Privy. Distance from nearest well__.______________________-.--____---_____.__._Distance from nearest building.______--____.____-___________----_-.--_. ❑ Distance to nearest lot line._.-___.__________________ __ \- — ------------------ ------------------------------------------------------- Remodeling and/or repairing (describe)--------- ------- --- C- �ii' rt ------------------•--------------- ----------------------- `----------------------•---- -- •--- ----------••--------------------- # ,,. 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,-and rules and regulationis of the San Joaquin Local Health District. (Signed)--- --- j/, �#�tL .E` :!! ---------------------- ------:(Owner and/or Contractor) By:-------------------------------------------------------------------------------------------------------------------- f------------(Title)------------------------------- -------------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY f APPLICATION ACCEPTED BY --------------- DATE--------------= REVIEWEDBY------------------------------------------------------------ ---•------ -------------------------------- DATE------------ BUILDING PERMIT ISSUED---•----------------=------------ ---- /_ "' - --------------------- DATE------------------`== Alterations and/or recommendations:.______.__.___- -----_ --------------- ------ -------•---•-•----------------------- ----------------- ----------------------------------- -------------- •------------------------------------------- ----------------------------------------------------------------- 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 Revised W-2100 i