3719 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No, _-7-L-.l--___ (Complete in Duplicate) Date Issued YOI-_513 Application is hereby made to the San Joaquin Local Health District for a permit to construct and This application is made in compliant with County Orr minstall the work herein described.ance No. 549. JOB ADDRESSD L ATG.- — r F Owner's Name___ _--I •�- - � - ---- Phone�Uo ---- -------------- ---.l•V • ' Contractor's Name. ------------------------------------------ -------------------------- _ ..__ . _ _ ------------------ i .- •----•------------------ Installation will serve: Residence []Apartment House ❑ Commercial ❑ Trailer Court ❑ Motu ❑ Other ❑ Number of living units: �-__ umber of bedrooms ----1_- Number of baths .__/__- Lot size __- .0 X --l-�------------------------------ Water Supply: Public system Community system E] Private ❑ Depth to Water Table ___- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam E] Clay ElAdobe Hardpan Previous Application Made: Yes ElNo W New Construction: Yes No El TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public se r is available within 200 fee{.) Septic nk: Distance from nearest well-- istan e,from foundt)on_/ Mater•al_-___-___--------------- �.{ No. of compartments__- ize_ ._ ,SC � Liquid depth-_-- -- J( fj -- ... istance from foundation_�_ ____-__�_ istance to nearest lot l,in�e Number of lines_____-_____ �'f �------ry: �� ._�Length of each line________ -- --0 Width of trench.- Type or,filter materia 7=' -" - ---------- --- - - Depth of filter material____._____ Tota( length__________-- �j �-_-_ Seepage Pit: Distance to nearest well---------------------- from foundation--------------------Distance to nearest lot ElNumber of pits----------------------Lining material-----------------------Size: Diameter----------------------Depth----------- -------------------- Cesspool: Distance from nearest well________________ Distance from foundation-------------------- material__.___________,____-_ -------------- ❑ Size: Diameter-----, --------- ---------Depth--------------------- ---------------- -- Liquid Capacity 8:'-gals. Privy: Distance from nearest well------------_------------------------------------Distance from nearest building Distance to nearest lot line________________________. ------------------------- ------------ Remodeling and/or repairing (describe):__._____________________ ----------------- I hereby certify at I have repay this application and that the work will be done in accordance with San Joaquin County ordinances, ru nd ulations of the San Joaquin Local Health District. (Signed)- ------ - --- --- -------------------------------------------------------- ------------------------------------------------ --(Owner and/or Contractor) t Title •-------•----------------------••------ ---• --- --------- ---------- ----------------------------------------------------- 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 13Y_ ______--------------------------------------------------------------------------------------- DATE-V--- REVIEWED ------------------------------------------------------------------------------ DATE----` - BUlLD1NG PERMIT ISSUED--------- -------------------------------------------------- j ----------•--------------•---------------------------------------- DATE------..I ! Alterations and/or recommendations:- ------------------------------------------- ------------------------ --- ------------------------ ----------- ----- FINAL INSPECTION BY------------ -------- ----- ------- ------------- --- - - Date---- ---- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 914 North "C" Stree+ Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 10-52 Revised W-2100