4302 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. ... (Complete in Duplicate) i ti Date Issued Application is hereby made to the an 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 AND LOC TION (p ��'• Owner's Name..... - - ----- ------ •------------------------------- -------------------------------------------- Phone--------------------------------- Address --Y .... -------------- -- G ( = -= �.j p 7 Contractor's Name..........�/- ---------------- ------t--------------------------------------•--------------------------------------- Phone..'l_40-`----- Installation will serve: Residence 1Q---Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel✓ Other ❑ Number of living units: __/____ Number of bedrooms ---a2. Number of baths J--- Lot size . __�1�-- a o-___________________________ Water Supply: Public system ❑ Community system ❑ Private [EDepth to Water Table .-yj� ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe�ardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes 9?1<o ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T k: Distance from nearest well-----(Qj�___ ( Distance from foundation__... --------M_a�jal_ C----- _ ------ __ ---- No. of compartments______-___�_ ___ -_. 6 ____.Liquid depth_.__�/._. -__Capacity...Yo . DisposSt,eld: Distance from nearest well? Distance from tdundation..__ _-Distance to nearest lot line-----/4...... [ Number of lines....... �__��_ -____'_.Length of each line.....n!�Q_______________Width of french----fir.. � Type or filter material__ ___I ___Depth of filter material-------.l_d-__--------Total length----------9.4__...... ._..� Seepa it: Distance to nearest well-.-----fS�-------Distance from fou ation..__ Distance to nearest lot�jline----S------- Number of pits---------/-___-____Lining material.�_e_: Size: Diameter.....s� --_---Depth------00, �............... Cesspool: Distance from nearest well-------------------Distance from foundation--------------------Lining material_________________________________ ❑ Size: Diameter------------------------------ ------.Depth----------------------------------------------------Liquid Capacity---------------------------- r Privy: Distance from nearest well----_--------------------------------------------Distance from nearest building-----------------------------------------. ❑ Distance to nearest lot line------------------------------------------------------------------------------------------------------------------------------------------- Remodelingand/or repairing (describe):.-------------------------------------------------------------•----•-------•-------•-•--------- --------------••--------------••--••-•••------........_. ---------------------------------------------------•----•-----------------------------------------------------------------•-----•--------------------------•---------------------•-------•---•---------- ---- -- --- 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. r and/or Contractor) it (Signed) -•---• o ----•• -------------- ---- ------------------------------------ ------ 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 V APPLICATION ACCEPTED BY-- -------- ---------- ---- ---- DATE-- '�-------------------------------------------------- ----------------------------------------------------- REVIEWED BY--------------------- --- - ----- DATE--- r'y�' ----------------- BUILDING PERMIT ISSUED------ ----•-• -- ----------------•---------••-••••--•---•---------------------------------------- DATE-------- Alterationsand/or recommendations----- ----------------- ------------------ -------------------------•-----------------------------------------------------------•---•-••------••---•••--•--- ---------------------------------------- -----------•----------------------------------...-----------------------------------------------------------------------------------------------•---------------••••............••--- ----------------------------------------•------------------------- --------------------------------------------------------------------------------------•---------------------------------------------------------- -------------------------------------------------------•----...------------------------------------•------------------------------------------------------------------------------------------------------------------------- --------•-•- ------------------------------------------------------------------------------------------------------------- ------------•-----------. -----------------•---------------------•--------.......... FINAL INSPECTION BY:-------- ..... Date . ',S"- 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 10-52 Revised W-2100