13470 - Laserfiche WebLink

Home Browse Search

Z APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) �p Date Issued ___. 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 County Ordinance No. 549. JOB ADDRESS AN&jLOCATION..-- ---- ...................... .f �4 .......... Owners Name----- = - ---.- Phe. Address- -- ---------- ---- ._.•. ---------- •--- -'`---------------G-- -• -.-- - --------------------------------------------------............................... Contractor's Name......... _�--- - -- -- --- ----- ... ........ . •-------------....... Phone..?.ffll/_.,1S/U Installation will serve: Residence Apar meet House ❑ Commercial ❑ Trailer Court ❑ Motel p Other ❑ Number of living units: _1_____ Number of bedrooms ..3.. Number of baths I.. Lot size _____________ ____________---------------------------- Water ______ ________ _______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 JM Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes) No ❑ New Construction: Yes ❑ Na 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 compartmen#s _ :- _ Size ------------------------------Liquid depth-------------------------Capacity....................... Disposal Field: Distance from nearest well_____, Q____ Distance from foundation......10........Distance to nearest lot line..-5./.... Number of lines__...............j----------------i Length of each line_...... ---------Width of trench.......A -------------------- Type of filter material....,441A......Depth of filter material'-------/j.. __.-_Total length........ -S-4......................... .41 i' S ge Pit: Distance to nearest well ,?a-___-._Distance.from foun}lation ---Ib.........Distance to nearest lot line S......... Number of pits__.,,,. ..........Lining materiai�_.�_..Size: Diameter.__.1.X.-��._.Depth--------y--- S' ............... Cesspool. Distance from nearest we l _______________Distance from foundation ---__--._-__---__-Lining material-_ -_-_..__ _.__.,-_._..._..... ❑ Size: Diameter----- ------------- t-----------Depth................................... ------------Liquid Capacity . •--------------•------gals. Privy: Distance from nearest well_________ _______ ___--_-_____-_______.__-Distance from nearest building_-_--_ -------------------------------- ❑ Distance to nearest lot line------- ---- - - ------ ------ ..:................... ---------------------------------------------------------------- Remodeling and/or repairing (describe):--_ . .......................................... I hereby certify 4hat t h2rve prepared.this application and that the work w11 be done in accordance with San Joaquin County ordinances, State laws, Rand ru-1es end regulefibns~of the Son Joaquin Loeat Healt#f`.pistricf. Si ned ( g )--------- - ---- --- ....... - 1OWnet afid/or Contractor) --------------------------------------------------- By:...... ---Q�----- - - - ------(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. ......,- r_�:.---•---_- -----_--------_- DATE... - REVIEWEDBY.........................----------------------------•--------------------�v I•------------------------...................................... DATE.................. ....................--•................ BUILDING PERMIT ISSUED.-...... .................I ... ................. ......._----------------------- ...... DATE..---------.. ..................................... Alteratons and/or IS - - ,.. ...... ---------------------------------- --,. --------------------------------------------- ------ ---•-------------------------.------------------------------------- f FINAL INSPECTION–B -- __ =. _ . :.' � -.- --------- -=------- ..------................................................ 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 -2100