7526 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. __IS a4__-_ (Complete in Duplicate) Date Issued __`y_I_a I__�_..(- 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. 549. JOB ADDRESS A D LOCATION_�__&h-- -----!7 -g-- Phone Owner's -----------e- ----------- _ -------L Address `---...------•-•-----•-------•--------•--------------q-- Contractor's Name------ ----- .� Installation will serve: ResidenceApartment House ❑ Commercial [E-`frailer Court ❑ Motel ❑ Other ❑ Number of living units: ________ Number of bedrooms -------- Number of baths ____ Lot size __--__-�%�_____.-,X._.1 ______________________ Water Supply: Public system 0- Community system [I Private E] Depth to Water Table t-Q ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam L- Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No I_ New Construction: Yes PNo ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest weII_X/[7,t._Distance from foundation__/.Q._F-------- _ ______________ ----------- 14' �- „� --,-_ ....Liquid depth-----&ct------------Capacity----- -------- Disposal No. of compartments ____/.'____._.Size__ __ Dispj-osal Field- Distance from nearest wefi_1.�/�.cJDistance from foundation__��- .......Distance to nearest lot �r Number of lines__________ �r...._length of each line--------��--"____.Width of trench.__.`_1___�.._-------------- Type of filter material----/-,3-----,5fepth of filter material____._ __._____._Total length-------� _______________________ Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance.to nearest lot line--___---___.__.__ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Dept h--------------------------------- Cesspool: Distance from nearest well--------_--------Distance from foundation.------------------.Lining material-------------------------------------- ❑ Size: Diameter--------------------------------------Depth-------------------------- ------------------------Liquid Capacity----------------------------gal Privy: Distance from nearest well--------------------------------------------------Distance from nearest building._______________________________._ ❑ Distance to nearest lot line------------------------- -----------------------•------------------------------------------------------------------------------------------- '?2.- -------------------------------- Remodeling and/or repairing (describe):----� _n____.__- ------- -•--. ------------- 1/_ ------•--------------------------------------------------------------------•--•--------------------•-••-------------------I--------------------------------•-•----•--•------------•------------------------------------------- ------•---------------------------------------•-----------------------•---------••--------------------------------•----------------------------------------------------------••-•-------------------•-•------•---------------- 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) c+-- --- ----------------------- (Owner and/or Contractor) -- „ --�. ---------------------------(Title)----------------------------------------------By:_ -- -------. . (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------ -- �.- -'-3ff ----- - ---- REVIEWEDBY------------------------------------- - -- ---�------------------------------------------•--. DATE------------------- ----- - BUILDING PERMIT ISSUED__..--•------------------ DATE----- --------------------------------------------------_.- Alterationsand/or recommendations------------------ ------------------------ --------------------------------------------------------------------------......------------.---I........I...,------ ------------•-------------------------------------------------------------------- - -------------•---------------------------- -----•---------------•---•--•----•--•----------_--------•-----•--------------•--• ---------------------------------------- ----------------------------------------------------------------------------•-----------------------------------------------•---------------_-----------------------------------•--- FINAL INSPECTION BY:.-- _ -- _- -- _ '- ----------------- Date..- �U--_--� 1_�----- 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 En---9-2M 145446 ATWOPP 1Z-S4