10681 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. .. .- C/ (Complete in Duplicate) 3 f 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 LOCATION._= Owner's Name......'------{ '----•----------------------------------------------------------------------------------- --------------- Phone-------------------------------•---- Address----- / - ---------- 1. ------ Contractor's Name --------------------------------------------------------------------------------------------------------------- --- Phone------------------................ Installation will serve: Residence.R Apartment House ❑ Commercial ❑ Trailer Court ❑ gqMotel F] Other ❑ Number of living units: -------- Number of bedrooms .-Z_- Number of baths ---I.... Lot size <_- _jt3-_________________________________ Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table-------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam 2 Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ 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________________-____--_--_-_-__-_______-__--: ❑ No. of compartments--------------------------Size-------------------------------Liquid depth--------------------------Capacity...... -__ Disposal Field: Distance from nearest well-0----------Distance from foundation._/_'_.__...._.Distance to nearest lot Ime_....._._.... Number of lines-------________________________ Length of each line-____36'___________-_-__-Width of trench_,y*.__._,..- Type of filter material! •__ Depth of filter material-/14 -__-________Total length.__3��_f'__e WO Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line----------------- 0 Number of pits----------------------Lining material_-_____•--------------Size: Diameter-----------------------Dept h--------------------------------4Z3 Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-__________-_______-________-:___-- ❑ Size: Diameter------------------------ ------Depth----------------------------------------------------Liquid Capacity.-------------------------gals. Priv Distance from' nearest well-------------------------------------------------Distance from nearest building ❑ Distance to nearest lot line - ----------- Remodeling and/or repairing (describe):-,AA- _ 4:49*11.....-- _ -------------------------------------------- ------ - -- - ------------- -------- . -- "� r -- C� �7ry __________________________•--------'---------------------------------------------------------_-------------' f I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St7f /l , nd ulesand regulations of the San Joaquin Local Health District. Si ned{ 9 )-�---- ------- -�"--.� `-=w�"=�--------------------•-----------...-- --------------------------------------------------------(Owner and/or Contractor) 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--+j=Ax- I"''?0-------------- REVIEWEDBY----------------------------------------------------------------------------------------------------------------------------- DATE-------------------------------------- -------------- BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE-----------------------------------------------...--- Alterationsand/or recommendations:-------•-- ------------------------------------------......------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------........................................... --------------------------------•----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------....... ------------------------------•----------------------------------- ------------------------------•----------------------------------------------------- ...................------------------------------------- FINAL INSPECTION BY:... _ --- -----------�-------------------- Date......r�n46...... --C�----------------------------------------------- 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 Revised 1.57 FY.CO.