6426 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. --- _----_- (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 described. This application is made in compliance with County Ordinance No. 54 JOB ADDRESS A +LO __ _TION___ _ Owner's Name---- ----- ------------ `.( '---- Phone--------- ---------------- Address--------- Contractor's Name.-. ... � ---- -------------------- Phone------ -------------- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _______ Number of bedrooms ________ Number of baths -------- 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 ❑ Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer-is-available vritki6'200 fee'et.) Septi T; nk: Distance from nearest well-----------------Distance from foundation--------------- ---Material__________-._--__-___________________._._____.. No. of compartments- ---- --- ---------------Size----•---•-----------------------Liquid depth------------ --- ---------Capacity----------------- --- Disposal Field: Distance fro m°nearest-we - _Ditstarnce from foundation----/e___"_.Distance to nearest lot line--- --__ - Number of lines____________ _ __ -Length _-_' _ !' _ ,______.Width of trench_ . � ___ _______ ae Pit: Dis ance to nearest well__ T e of filter material-- _, of each line_____1�_v Depth of filter material ---Total length------ -- -- ----------------------- See _ _ _D stanc _ Seepage ____________ e from foundation_____ _._____._!..bistance to nearest lot line------------ ❑ Number of pits--------------....-___Lining material---------------------:.Size: Diameter---------------.-------Depth---------------_----------------- ,1 d � Cesspool: Distance from nearest wefl__________.:.__Distance from`foundation----------------- _Lining material----_---------------:_.___________.__. ❑ Size: Diameter.- -------- ----------Depth-'----------=--•------------- -----------------------Liquid Capacity------------------------------gals. Privy, Distance from nearest well--------------------------- -: '__-,=F_Distance from nearest building 9------------------------------------------El `\ Distance:to.nearest lot line. (i_... = =' ------------ -------------- Remodeling and/or repairing (describe)____________________..._._-.----- -----------------------------------------------------sk ------------------------------------------------------------------------------------ -----------•----------------------------------------•---•-----------•--•---------------------------------------•------------------------ •-----------------------------•------•-----•---- ---------------------------------------- -------------------•------ ---•------- ------------------------•-•---- = ---------- ------------------ 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, es and rec flatians of the SanrJaaq_uih Local Health District. (Signed -------- -------: - ------------- =-----= ---------------------------- -- -----------------------------------------(Owner and -Contractor) , By:.......------------#------------------------------------------------ ---------------------------------•-•------------------------(Title)---•----------------------------------------------------------- (Plot plan, showing size of lot, location of system in relation-fo wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- ------- - --- ---- --- ---------------••------ DATE_ ----------------------- -------- --------- REVIEWEDBY------------------------------------- ---- --------------------------------------------------------------- DATE-- BUILDINGPERMIT ISSUED ------- -- - --------- ------- ---------------------------------------------------------------- DATE------------ -----------------------------•--•- Alterations and/or recommendations:---------- --- - -----------------------------------------------------------------•----•---•--•............ -•------------•-------•----•- ----------------------------------- -------------------------- ---------- - .. . ............ ------- ••-----------------------------------------I. -----------•------- .--•--------_----- •-------•--•--- 1 --------------------- ------- -------------•----------------- ------------------------------------------------------- ------------------------------------------------•----------------------•----------•---•-•-- (_ --- ---------••-- FINAL INSPECTION BY:---------- 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 E5�9-ZM 145446 ATWOOD 12-54 4