10741 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. (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 applicafion is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION---- ------------------------------------------------------------------------------------ Owners Name--- ------------- -------- - ---------------_--------------------------------------- Phone--------------------------------- Address-------------------------------'�__ _ --- Contractor's Name--------------------------------•------------------------------------------------------------------ - -------------------------------------- Phone.---------------------- - Installation will serve: Residence V[ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _ ____ Number of bedrooms _ __ Number of baths ___�___ L45.z _�-�-Q__ ____a__t-_. ____________�Water Supply: Public system ❑' Community system ❑ PrivatertV Depth to Wateable /0- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobejr. Hardpan ❑ Previous Application Made: Yes ❑ No- J4_ New Construction: Yes ❑ No,%O,FHA/VA: Yes ❑ No k TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 fee+.) Ski rk: Distance from nearest well_______________Distance from foundation--------------------Material______________._______________________________- No. of compartments--------------------------Size--•-----------------------------Liquid depfh--------------------------Capacity----------------•------ Disposal Field: Distance from nearest well•_-_6.0_____.Distance from founaatipp.._l.-/..57.. -. istance to nearest lot liP�__ib____..- �_ Number of lines------ _________Length of each lin _ idth of trench____ ----------------------- Type ____-___________.____ Type of filter material-e --------Depth of filter material___��_____---------Total length__-_f-L - 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 material______.____________________________- Q ❑ 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)----------- -------------------------------------------•----------------------•--------------------------------- ------------------------------------------ ---------------------------•-----------•----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- \ ------------------------------------------------- ------=-------------------------------------------------------•-------------------------------------------------------------------------•-------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State Ia s, and rules nd regulations, f the San Joaquin Local Health District. {Si ned g )-,r ------ ---- -- �--- -- -�-- -- --- - ----- -- -------------------- --- --------(Owner and/or Contractor) ...,a 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 APPLICATIONACCEPTED BY-----------------�---- ---------- ----- -- ------------------------------------------------------ DATE------------------- - -- -�---='�------------- REVIEWED BY_______ -_ DATE______________ _ BUILDING PERMIT ISSUED------------------------- ------------------ DATE_-------------•--------------- Alterations and/or recomme da 'ons' 3-_3�-01------�-a�-------I�-- , -- ----------- ------- ------------- ----- � - � ��'�-� - , .. ' r�.-° r� tZAI - 1 .��_►t ... � --------- ----- - - ------------------------------------------------------------------------- ------- -- - - ---- -- - .D FINAL INSPECTION BY: .n.�_ Date4 ------� ------------------------- Is 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 E5-9-21x1 Revised 1-57 F.P.CO.