2979 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) v� Z- -". 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 wfLh Cgu y Ordinance No. 549. JOB ADDRESS AND LOCATION------ � �?`.----�rg_•cJ_--'9---------------J Owner's Name----------ixi-----pl,------ � „ -------- - --------- Phone------ o""----------------- --------------------------------------------------------------------------------- Address = Contractor's Name--- ------------------------------------4_4:f�_v --------------------------------------------------------------------------------- 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 within 200 feet.) Septic Tank: 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 to nearest lot line----._-...-_----- ❑ Number of lines------------------------------------Length of each line------------------------------Width of french----------------------------------- Type of filter material-------------------------Depth of filter material-------------------.-__Total length-----_---_-_----___-------__----__---._ Seepage Pit: Distance to nearesf.well----------------------Distance from foundation------------------- Distance to nearest lot line___-----_----- ❑ Number of_pits----------------------Lining material-----------------------Size: Diameter.-----------------------Depth-------------__-__--_---_:-- Cessl: * Distance from nearest well-----------------Distance from foundation------------------- Lining material-----------------------------..____--. [�g ' #_V V' Size: Diameter----------------------------------------Depth----------------------------- -------I- --------Liquid Capacity------ --------------------gats. i Privy: Distance from nearest well-------------------------------------------------Distance from nearest building--------.-_--------____-----_--_-_----. ❑ Distance to nearest lot line------ C------------------------------------ ---------------------------------------------------------------------------•-------------------- I Rem deling and/or repairing ,(describe)---- '� --------- - ------r--------------------- - -- i 0-14 `" "----------- ---- ------ --------- - ------- - ------- hep= r! -------------------------------------- � � - ------------------------------------------- --------- ----------- --------------------------------------------------------- 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 regulations of the, San Joaquin Local Health District. (Signed) --------- ----------------(Owner and/or Contractor) By:-------------------------------------------------------------- ---------------------------------- --------------------------(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 ,. APPLICATION ACCEPTED BY------------ ---------------- ----------------------------------------------------- DATE---------- ------------------- REVIEWED BY------------------------------------------- ------ DATE---------- BUILDINGPERMIT ISSUED--------------------- ---------------------• --------------------------------------- DATE----------------- --_--,----------- Alterationsand/or recommendations------------------------------------------ ------------------------------------------------------------------------ ----------------------------- ---------- -------------------------------------•----------------•------------------------------------------------------------ ---------------------------------------------------------------------------------------------------------- -------------------I------------------------------------•---------------------------------I-------------------------------------------------------------------------------------.--------------------------------------•------ --------------------------- --------------------------- ---------------------- -.-::---------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------ FINAL INSPECTION BY-------------------- J- v------------------ Date-------- -- -4------------------- SAN -- ------- SAN JOAQUIN LOCAL HEALTH DISTRICT t ' 1 130 South American Street 300 West Oak Street t32 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 8-51 Revised W-2100 ,k