2186 - Laserfiche WebLink

Home Browse Search

op APPLICATION FOR SANITATION PERMIT Permit Nov? ` _ ----- 4-2—A (Complete in Duplicate) e2 ...Date Issued/'___-J 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. nn I 1 JOB ADDRESS LOCaRTION- 1!: ----------- ---------------- ---- -------------------- ----------- Owner's Name :• - Phone k ...... Address---t--aJ... Contractor's Name-- ---------------•-------------------•-•---• ---- Phone................................... Installation will serve: Residence/ [Apartment House ❑�j Commercial F] Trailer Court F] ❑ Motel ❑ Other j �J Number of living units: __1-___ Number of bedrooms ._ht__ Number o baths ---I-_ Lot size __- . ___ Water Supply: Public system ❑ Community system 0 Private epth to Water Table -------- ft. Character of soil to a depth of 3 feet: S clZ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe[Hardpan Previous Application Made: Yes ❑ No [+ New Construction: YesNo TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank on cesspool permitted if public sewer is available within 200 feet.) Septic Taqk: Distance from nearest well.................Distance from foundation___------_----------Material. __'__--------------------------- ❑ No.. of compartments---- Size-------- -------------------Liquid depth---- ------- ------Capacity ------ ------ Disposal Field:, Distance from nearest well-----------------Distance from foundatio Distance to nearest lot lin �I - k it Number of lines.. Length of each line_._____- Width of trench r Type of filter materia__-______/tp g --------------------- Seepage - De th of filter material--------_�_. ___Total length __________________ Seepage Pit: Distance to nearest well__ __________________Distance from foundation___-___:_-•--_.-.••.Distance to nearest lot line--------_-_---- 171 ______.__._----❑ 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 --------------- ----- •---Remodeling and/or repairing (describe):------ ---•--------------------------------------- -------- -------- -------- -------------------------------- ------------------- j ------------------------- ------------------------------------ ---- ---- ----------- ----------------- --- ---------------- ------------------------------------------•-- -------- --- ------- ---------------------- ----- - --------- ---------------- ------ ----- ' ------- -------- ------- --------------------- -------- -.---- ------- ------ -------------- ------------------- ---•--- -------- ------- --•----- ----••-•-..------- I herebycertify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County ' ordinances,j§fafe laws, and rules and regulations of the San Joaquin Local Health District. (Signed) - --------------•------------ --------------------- ----- ----------(Owner and/or Contractor) By:---_-- ---------------------------------------------------------- ------- --------------------- ----- ----- ---(riifle)---- ---•-- (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_ REVIEWED BY- ------------------- .. -- ----------------------------------------------------- DATE_ -sr ------ BUILDING PERMIT ISSUED-------------------- --- ------- --------- _--------------_-- --------- DATE - --- Alteratio and/or recommendations--------------------------------------------------------------- -------- ----- ------ •--•---- ------------------------------------------ - ` --- -----------/--------------- ------ .. . ... ---- - ------------• - ---------------------------- ----- -----••... ------ .••--- .- --------------------------------- ---- - ------ .--- Al FINAL INSPECTION BY: --- -------------••-•-• Date--------- "�.'7.'..ir-1 .------. •----------------- 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 8-51 Revised W.2tW.