2170 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Pe mit No. --_- a (Complete in Duplicate) Date Issued l_'�`�-_"_`'�•� 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 Count Ord;��. 549. JOBADDRESS A OCATIO -----------------------v-----------------------------------------------------I---------------------------------------------------------- Owner's Name---- -- -- ---- ---------------------------------------------- ----------------------------------------- Phone------------------------------------ Address------------------ �_S--- ` --- -------------------------------- Contractor's Name--------------------------------------------------------------------------------------------------------------------------------------------- Phone----------------------------------- Installation /----------/----- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other �7i7�cr�1rE.C� S Number of living units: j-_- Number of bedrooms ________ Number baths*--_-_- Lot size ------------------------------------------------------------ Water Supply: Public system E] Community system ❑ Pr Oepth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy Lo;'�No Clay Loam [:] Clay ❑ Adobe �rdpan E]Previous Application Made: Yes E] No New Construction: Yes ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: h (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation-------------------.Material------------------------------------------------ El No. of com artments--------------------------Size--------------------------------Liquid depth----------- -- -___----_--Capacity __ Disposal Field: Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line----------------- El Number of lines-----------------------------------Length of each line------------------------------Width of french--------------__.................-_ Type of filter material------------------------- of filter material-----------------------Total length__-------------------________-_---_-----__ Seepage Pit: Distance to nearest well----------------------Distance from foundation---------------.---.Distance to nearest lot line_______-------_-_ ] ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth _----.-_---- t1__- Cesspo Distance from nearest��'ef1--_/'�_ ---Distance from foundation_----7-�------Liining material-- --------------- ___. ~j Size: Diameter-------------�t-_x►-� L� Depth Liquid Capacity l�� galls. , Privy: Distance from nearest well-------------------------------------------------Distance from nearest building__________-_-_-_-_-_---------___---__--_. ❑ Distance to nearest lot line---------------------------------------------------------------------------------------------------------------------------------------------- Remodelingand/or repairing (describe)-------------------------------------------------------------------------------------------------------------------•----------------------------------•- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ i I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed) , -- ---- --------------------------------------------------------------------------------- ----------------------(Owner and/or Contractor] r 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--- ------------------------------------------------- '� REVIEWED BY------------------------------------ DATE -------------------------------------------- BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE--------- t Alterations and/or recommendations:---------------------------------------------------------------------------------------------------------------------------------------------------------------- ---- - - -------- -.-cf-------------------------------•------•-•--------------------------------------------------- ---------------------------------------- --- ------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- FINAL INSPECTION BY:----- ------------------------------------------ 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 8-51 Revised W-2100 1