11683 - 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 application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION_____ - --- - - --------------- -- --- ------------ Owner's Name---- -------- - ---- _. ------------------------------------ -------------------------- Phone------------------------------ ------------------------------ -------- ------------------- Address Contractor's Name___ _ _ Phone ---------------------------------------------------------------------- Installation will serve: Residence ❑ Apartment House ❑ Commercial N Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ______ Number of bedrooms ________ Number of baths ___t___ Lot size _S' ----------------------------------- Water Supply: Publics system F1Community system prPrivate E]Depth to Water Table ________ ft. ` --.! Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam M Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes Jj] No•❑ PHA/VA: 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 weil_1_trb-- ---- Distance from foundation --- _0' ......... Material__-____---__ 1 No. of compartments -----;L ---------------- Size ---- ?' _%3--4�-----v-_Li --Liquid de th__-- _ - -------------- aci q p '- --- Cap t '-f .-------- Disposal Field: Distance from nearest well -_ 1_"! Distance from foundation --- I P__`__________ -Distance to nearest lot line --- k__�-------- Number of lines ---------- 3..__._ Length of each line _______'________________.Width of trench ---gk__! Type of filter material _. __ __Depth of filter material____! length y -------------- _________________________________-_______ Seepage Pit: Distance to nearest well-jo-__________Distance fr m foundation -____I.0_'_______. Distance to nearest lot line --- �j Number °ia of pits___._I________________Linin material___..____ 3 -- r 9 ----Size: Diameter ---3- r -Depth_._''L'5--------------------- ` Cesspool: Distance from nearest well ----------------- Distance from foundation ______------------ .Lining material Size: Diameter Depth F -------------------------------- Liquid Capacity----- ----------- -------gals. r Privy: Distance from nearest well ---- _--------------------------------------------Distance from nearest buildin ❑ Distance to nearest lot line - - ------------- --------------------------------- Remodeling and/or repairing (describe)_ --------- __________________-_ 1 --------------------•------------------------ -------------------------•------- _ ` -- ---------------------- 1 -------------------------------------------- ---- - --- 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 Jaa_quirs Local Health District. (Signed)-- 1 % A, ---------- -------------- - - -- -� - -- -------------- --------- - - - ran or Contractor) gY=� ta - ---- -•--------- ----- --------------------- ---------------------------------- (TitleP- Yt --/P C,a (Plot plan, showing size of of, location f system in relation to wells buildings, etc., can be laced on reverse side). - ' FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED 8Y__ r� r _____________ DATE_____'_ '_---p_.___-_-_ ------------------- - REVIEWED BY--------------------------------------------------------------------------------------------------- - DATE-------------------- - ------------------- - -------------------------- BUILDING PERMIT ISSUED-------------------------------------------------------------------------------------------------- DATE-- -- ----------------------- Alterations and/or recommendations___________________.___ --------------------------------------------------- •---- FINAL INSPECTION $Y:.�r�rd1l " Date 7 3 _- ��---------- h SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street Stockfon, California f Lodi, California Manteca, California ES 9-2M Revises 1.57 F,P,CO. 814 North "C" Street Tracy, California