10311 - Laserfiche WebLink

Home Browse Search

l APPLICATION FOR SANITATION PERMIT Permit No. .&;_ _Z/_.... (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 LO TION___ a -------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------- --------•---------------- Owner's Name-------- - - `-------------------------------- --------- ---------------------------------- Phone------------------------------------ Address--------- ------- --------------- ----•--•------------------------------------ Contractor's Name-----------------6-' ~-------- -------------------------------------------"-----'-------------------------------------- Phone----------------------------------- Installation will serve: Residence�Apartment House ElCommercial-❑ Traier Court ❑ Motel ❑ Other E]Number of living units: ----I - Number of bedrooms 3__ Number of baths _ -_'__ Lot size ___ __ _ __T__ ________________________ Water Supply: Public system J< Community system ❑ Private ❑ Depth,to Water Table 3.6— ft. Character of soil to a depth of 3 feet: Sand ❑ , Gravel ❑ Sandy Loam❑ Clay Loam ❑ Clay ❑ AdobeZ[ Hardpan ❑ Previous Application Made: YeqJ6 No New Construction: Yes ❑-No;<FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: 4 (No septic tank or'cesspool permitted if public sewer is avarilable within 200 feet.) Septic Tank: Distance from nearest well____,_._______-__Distance from foundation-------------------Material------------------------------------------------- ❑ No. of compartments----------�- z----Size------1---------------- Liquid depth p tY ___Ca aci Disposal Field: Distance from nearest well--------A.._.Distance'from foundation---------------------Distance to nearest lot line----------------- ❑ Number of lines-----------------iw-------- Le gth of each line------------------------------Width of french----------------------------------- Type of filter material--------------- --�/D'epth of!filter material-----------------------Total length___._____________________________-____--__ Seepage Pit: Distance to nearest well_._.________________Distance,from foundation--------------------Distance to nearest lot line___________._____ ❑ Number of pits------------ ---------Lining m erial---:-------------------Size: Diameter-----------------------Dept h------------- -------- R, Cesspool: Distance from nearest well-_=/- _-___ istance from oundation_ _�_�.__..Cining material D 3k Size: Diameter- -4�-----------Depth-------- - -................................... -------------------------- - --Liquid Capacity �j gals. f `` _ Privy: Distance from nearest,well------------------------------_------------------Distance from nearest building------------------------------------_-_._. ❑ Distance to nearest lot line------------------- ------------------------------------------------------------------------------------------------------------------------- Remodeling and/or rep ing (describe ------ ---- -------- v r - - •---------------------------------- -------------------- ----- ---------------- - --= 1 hereby cert' y that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules an regulations of the San Joaquin Local Health District. ($igned) ---- -- -- --- (Owner and/or Contractor) By:-------------------------------------------------------------- ---------------------------------------------------------------------(Tifle)---------------------------------------------- ---- (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--- --- ATE-- /- --r� REVIEWEDBY----------=------------------------------ -------- ---- -- - - - --- ------------------------------ DATE I- f BUILDINGPERMIT ISSUED------------- ------ -------Z--- - ------------------------- ----- -------------------- DATE------------------------------------------------------------- Alterations and/or recommendations c------------------�--------------------------- ------------------•----------•------------------------------•--•-------------------------------------- -- --------------------------------•----------------------•-•----------------------------------------------------------•-----------------------------------------------•- ------•_---------------------------------------------- .1 FINAL INSPECTION BY:. ft ---iF-- Date `� �'--. .. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street r 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Reviseci 1-57 F.P.CO.