8885 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. _..- (Complete in Duplicate) Date Issued _.__.___s f---- 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 9,ountX Ordinance No. 549. t JOS DQRESS AND LO ATION__ � �' " "T ------ _ ------------ ------ (1, -._. Pone----------------- --------- ------ Owners Name--- --- -------- ------------- - ------- ------ ------- ----------- -- - - -------------- - 1 -------------------- Address-----•----•- ---•---- -------- Contractor s Name------- ------ ---------------- Phone--------•------------------•------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of bedrooms -_-t--.- Number of baths ----/-. Lot size __-- --------------------------- Number of living units: --I---- Water Supply: Public system ❑ Community system [:f Privateo Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe f Hardpan ❑ Previous Application-Made: Yes ❑ No"% New Construction: Yes El No lJ� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Sep'lic Ta — Distance from nearest well____.-.----------Distance from foundation--------------------Material_:.-.-----_.___--..----.__-_------________--_-. � No. of compartments- -Liquid,depth--------------------------Ca Capacity- - --- -----,,---y--Size- -•- - 'TL P y----- -- (fi isposal Field: Distance from nearest we€I__��. .1._Distance from foundation__-__-q-- -- to nearest lot line_- �.. f Number of lines___.._._L___________________ _Length of each line--------I_flD............Width of trench----_____.��'.�._.-_.---------- Type of filter material._..5-� -Depth of f4er material--.._-t---43-------- otal length--.-----1_i ____________________ Seepage Pit: Distance to nearest well---------------------_Distance from foundation---.---------------Distance to nearest lot line----------------- F-1 Number of pits---------------------Lining material-•---------------------Size: Diameter.----------------------Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation------------. ------Lining material----- F1 Size: Diameter Depth- -------------_ - ------Liquid Capacity -------------------.------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building---------------.-.._-_______._-.-_-_----. ❑ Distance to nearest lot lire- ------------------ --------•------ ---•----------------------------------------------/------------------ Remodeling and/or repairing (describe):-----------`:.� �.�1 � " s 1 ... ::----- ------------•------------------------•------------•------ t-----• --------•---------•--- -- -------------------------------- -------------------- ------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, 5ta ws, and4. 1 and regulations of the San Joaquin Local Health District. __________________________(Owner and/or Contractor) (Signed) 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 APPLICATION ACCEPTED BY---- -------------- ---------- ---- ----------------------- DATE ---------- REVIEWEDBY----------------------------------------------------------------- - - - - ---------------------- DATE -------- DATE.-------------- --•------------------------4--------••----- BUILDING PERMIT ISSUED------------------------------ ------- ------ Alterations and/or recommendations:-------------- --- -••---------------------------- -----------•--•---•-----------------------------•------------------•------- -----•---- ----------------------------------------------------------------------------------------- ----------------•------•--------- •-------------------------------------- -------------------------------- --------------------------------------- ------------------------- ---------------------------------------------------------------------------------------------------- � 6 rel FINAL INSPECTION BY------ ----------Z-------------------- ----------------------- Date - -------------------------------- 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 gg-9 145446 nrw000