4665 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. (Complete,in-Duplicate) N /d 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. 1 JOB ADDRESS AND To Owner's Name ---- --- --------- . ----- Phone------------------------------------ Address------------------------ ----------- _ __ oA ____ __-____.-_-»_____ _____-_----___---__--_______-.__...._..._.... Contractors Name=:7- ----=- F T ------------- Phone----___------------------------ Installation will serve:,:,.%Residence ❑, Apartment House ❑+.Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: .)____ Number of bedrooms ---01 Number of baths -------- Lot size ----------5V� - - t�'G/ +....: ..sysf;— err wr w Water Supply: Public system orrimunrfiy system ❑ Private ❑ Depth to.Water Table ________ ft. Character of sail to a depth of 3 feet: I Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ Previous Application Made: Yes ❑ No EIr1ew Construction: Yes jjk--I'do❑ TYPE`SOF INSTALLATION AND SPECIFICATIONS: i (No septic tank or cesspool permitted if p blit sewer is available within 200 feet.) Septic Tank: Distance from nearest well_ _ _ _Mance from foundation__ __ t ri�l__�� __. I No. of compartments_.___�F______Size ____ _ _:___Liquid dep ....... _._Capacity___ - Dispo al Field: Distance from nearest well _.Disterickrfrom+4fouundation_ _�_. _ _13istance to nearest I I'n .�.__r --- Number of lines------ �+ Length of each dine_ _ _' _.Width' of trench.___-_ - __----.---- T e oT' filter materiap J_�__Al- _.Depth of filter material_-__ ______!... length__-___._�.� --- Seepage Pit: Distance to nearest well___ __________________Distance from foundation--------------___Distance to nearest lot.line-_______________ ❑ Number of pits------- #------ Lining material-----------------------Size: Diameter----------------------Deptn-----------------------•--------- Cesspool: Distance from nearest well_________________Distance from foundation---------------I_._Lining material__.___---__._______.____._____--_-___ ❑ Sizo: Diameter----- -- --------------------------.De th-------------------------------------- 1 1 - -- .--Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-----------------------------------------. ❑ Distance to nearest lot'line_____:.________________________________ M ----------- i Remodeling and/or repairing (describe):----------------------------------------------------------------------------------------- - 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 Jules and regulations of the San .Joaquin Local Health District. (Signed) ------ --------- ------- ------------- --------------------- •---------------{Owner and/or Contractor) B • (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- •-------------- BUILDINGPERMIT ISSUED----------------------------- ------------------------------------------------------------------------- DATE Alterations and/or recommendations:------------------------------ -------------------------------------------------- ------------------------------------------------------------------------ -----•------------- ---------- ---------------------------------------------------------------------------------------------------------------- � y � S FINAL INSPECTION BY:.- ---------- Date------- -------------- .✓_ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oalc Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M I0-52 Revised W-2100