3608 - Laserfiche WebLink

Home Browse Search

)\n ( 0 '� APPLICATION FOR SANITATION PERMIT Permit No. -��?; ..... Com lete in Duplicate) - (1'} ( pDate 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. r JOB ADDRESS AND L ATION.--•-•--•' - 0. _.. -- (G�.Grrt'cc.t>)----------------- --------------------- 01 Owner's Name............ •-- -- -....... •• •--- -- --------------------------------- Phone_. ....40 Address............. ... . ---• ----- ..... -- Contractor's me -------.. Contractor's ----- Phone.........-•-•--•-•-•----•--•------ Installation will serve: Residence Apartment House ❑ C mercial ❑ Trailer Court ❑ Motel ❑ Other f'- ❑ Number of living units: __ -_ Number of bedrooms _� j----Number of baths ____ Lot size __,,,,.rte� , ,1,.T-_-!�___________________ Water Supply: Public system,_PCCommunity system ❑ Private ❑ Depth to Water Table-<;.�tt. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe_jy Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes ❑ NoJW- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ,Septic Tank: .. Distance from nearest well ________________Distance from foundation--------------------Material------------------------------------------------- gvq$�?, 00No. of compartments..........................Size-------------------------•------Liquid depth --------- ------ Capacity-•-•------- --•- Disposal Field,: (/ Distance from nearest well---.-------------Distance from foundation--------------------Distance to nearest lot line................. OF ► �JN Number of lines___________________________________Length of each line...........___.--------------Width of trench-----------------------------------0 fl Type of filter material---------------------o__Depth of filter material-----------------------Total length.__.____._.______.___._..__............................................ Seepa a Pit: Distance to nearest well Distance f fo dation -.Distance to nearest lot line_._ ____. tr Number of pits----- mmg material _ ______ Size: Diameter___ _--Depth_--___�.�'��._____.___._. ------ Cesspool: Distance from nearest well__---------------Distance from foundation--------------------Lining material-_------------------------------------- ❑ Size:. Diameter----- ----- ------Depth------------------------------------------------- Liquid Capacity-`------- -------- --gam-- — Privy: Distance from"nearest well------------------------------------------------Distance from nearest building______-__.____._._-______----_._:___-___.' ❑ Distance to nearest lot line-------------- ------------- ------------------------------•-•------------------------------------------•----------------------------------- Remodeling and/or repairing (describe:--.-------- =-----------------------------•-----------•- - - ---.-.------•-••-•------•-•--------------------•----•----•----------------------------•--------------•-----------------------------------------------------------------•----•-----•----------------------------------- ------ .--•-•--------------------------------------- •-----------------------------------------------------------------------------------------------------------•-------------•------------•--•-------•------------------------- 1 hereby certify that I have prepared this application;and that the work will be done in accordance with San Joaquin County ordinances, State I d rul n regulations the San Joaquin Local Health District. Sined -----'--------- - -- --- ----- - ----------------------- --- -Owner And/or( 9 )----------------- ---- -- --- --•------- ------------- - ---- - • - - -- Contractor) By:... -------- :. (rtle -- ---- - (Plot plan, showing ize of lot, location of system in relation to wells, buildings, etc., can be cad on reverse sid FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY- - ----------------------------------------------- ......................... DATE --------------------------------------- ------ REVIEWED BY------------------------__ - ------ ------------------ --------------------------------------------- DATE-- -- - ------------------------- ~ BUILDING PERMIT ISSUED ;------------------------------------------_---------------------------------------- - -- DATE----- --; '- Alterations and/or recommendations:...................... --------------------------------•----------------..................................... ----------------------------------------------------------------------------------I--- -- -------------------------------------------------------------------------------- ------- - ------------------------------------------------------------------- --------------------------------------------------- FINAL INSPECTION BY----------------------- - ----------------- 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 ES-9-2M 10-52 Revised W-2100