2605 - Laserfiche WebLink

Home Browse Search

F APPLICATION FOR SANITATION PERMIT Permit No. c� __ (Complete in Duplicate) 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 its made in compliance with County Ordinance No. 549.= /0 JOB-ADDRESS AN O ATION----- --- - Owner's Name------ -_--- . .....I!- ----- --------------- ---- - -- Phone .. ...._ Address------ � t L� � - -- 7 L ------- -•------------ ------ - --- - ------ - ----- --------• .............................. Contractor's Name...T3_f'ZV7K/L------------------------------------------------------ --------- -------------------------------------------- Phone------------- • -----....----- Installation will serve: 'ResidenceJ�r Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel El Other ❑ . Number of living units: __ ___ Number of bedrooms __ __ Number of baths - :__ Lot size .._.... ........... Water SuPP1 • Publics stem Community system �Private ❑ Depth to Water Table—l . .` Character of soil to a depth of 3 feet: Sand Gravel ❑ SandY Loam RR"'Clay Loam❑ Clay Adobe❑ Hard an G I? . Previous Application Made: Yes ❑ No g?' New Construction: Yes [R-'No ❑ ' TYPE OF INSTALLATION .AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet+..)r Septic Tank: Distance from nearest well--- d -_Distance from foundation--f,t. --- ..Maferial--� .!...:!.......1----- No. of compartments__.___ � ____Size....�___X4.1' �_-41----Liquid depth--15^V9-____--.Capacity.j -- Disposal Field: Distance from nearest well C1,Distance from foundatio ,'OLTDistance to nearest lot line IQ ' Number of lines.. fl Length of each line-....... �{ :Width of trench " t Type of filter material--- f.'..--,�r�_•Depth of filter ma terial.......__l�_----Total length..._._._. Q_.� .................. Seepa Pit: Distance to nearest well -4 1P!0�_Distance fr foundationn ": tance"to nearest lot li e Number of pits r, "`'""^ Lining material_ 'iia-. Diameter 4 " _._.Depith.. --- r Cesspool: Distance from nearest well.................Distance from foundation -------- ---------Lining material.. ..____.._.._.--_-. ❑ Size: Diameter--------------------------------------Depth------ ----- --------------------------Liquid Capacity---------------_-----------gals. ` . µ t . ..;Y !,', estwllDsanceom fie ------------------ -•-.----Distance from nearest i - '.^, ..�_..�-.. _._s Privy: ❑ Distance to nearest lot line------- ------ ------- ---------- --- --- 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 J90quin County ordinances, State laws, and rules and regulations of the San Joaquin Local•Health District. Owner and/or Contractor (Signed)-- - y - ( / BY---•----- -•---• ----•----- -- ---- ------- --. -------. .. .--- -------------------------------(Title)--.IGV1.� • (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------------------------------------------------- BUILDING PERMIT ISSUED-- --- ---- -------- ----------------------• ------ ............................... DATE -----•---- --------•- -- •------- ------- Alterations and/or recommendations- ----------------------------------------- ----•-. .--------- --...• . ---• -----•- ..._ - -..----- FINAL INSPECTION BY: - ,/ _.. Date G SAN JOAQUIN LOCAL HEALTH DISTRICT V 130 South American Street 300 West Oak Street 132 Sycamore 4freet 814 North "C" Street" Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 8-51 Revised W-2100