11386 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. (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 is made in compliance with County Ordinance No. 54/9. JOB ADDRESS AND OCATIO --7. .. d - - ----- -----------I----------------------------------------------------------------------- `i Owner's Name - _ - - - - .- Phone--- -------------------- Address ------------------- Address-------------------- ------------ - ---- / ----- - ? ------- - T= --------- ----- ----- Phone_Contractor's Name-- = Installation will serve: Residence 5E��Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __�---. Number of bedroom,3-.- Number of baths ._(.-_ Lot size -------r.019-1---x...iJL ---------------- 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 ❑ Clay Loam ❑ Clay ❑ Adobe,p Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ NoX FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r c Distance from nearest well-----------------Distance from foundation-------------------Material---------- -- _-_________- ------------ No. of compartments------- --�-�------ --Size-------------------------------Liquid depth--------------------------Capacity----------- osal iP�Id: Distance from nearest well'r-- --------Distance from founda ' �-4.' Distance to nearest lot line_ Number of lines______ Length of each line_ `_. `__.Width of trench_�.�_'.'... pp y- - g * Type or filter material..-;.1�- _Depth of filter material-_----/-9`-r---__._Total length___/--:Z- Seepage Pit: Distance fo nearest well----------------------Distance from foundation-------------_......Distance to nearest lot line--------- `✓-_- ❑ Number of pits------------------_--Lining material-----------------------Size. Diameter---.----- .. Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation- ------ Lining material__..._----------_-..-____---____-___ ❑ Size: Diameter---- -------------------- ----------- Depth------- ------------- ----------------Liquid Capacity------------------ - - -gals. Privy: Distance from nearest well-----------------------------------------------_Distance from nearest building ❑ Distance to nearest lot line--- -------------------------- ----- - . Remodeling and/or repairing (describe):. --�f,--��_ eczl ---- c-r?�- ----- ---.................................................... -- ---------- -- s--- ----- --------------- - :� -_ __ ---- - ----------- --------------- ------------- -------------•-------- ---------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordan a with San Joaquin County ordinances, Si laws, and rules and regulations of the San Joaquin Local_Health District. J� (Signed} - ------- '�4 _ -- - ---- ------- Contractor-- ---------- (� ) By:---------------------------------------------------------- --- ------------- '; - (Title)------------------- --------- --------- --- - ----------- ----- (Plot plan, showing size of lot, location of system in rela*i to wells, buil gs, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- '� ' ------------------------------------ DATE........ � REVIEWED BY..----- ' ------------------- ,_ r 'i - DATE ---- ------- BUILDING PERMIT ISSUED ` ----- -- -------- --. ------------------------------------ ---- ------------- DATE. Alterations and/or recommendations:-------- --------------------- ----------- ----------------------- ---- ---------- -- - -- ------------ ---------------------------------- ----------- --------------------------------------------------------------------------- --------- ----------------------------------- ------------- --- - - r - -------------------------- ... ----- ..._ . 11 -.... FINAL INSPECT1C_N--B*_ -- 1 �� - ------ - --- 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 Ravisaa 1.57 F,P.CO.