1092 - Laserfiche WebLink

Home Browse Search

s)�1 APPLICATION FOR SANITATION PERMIT Permit No. �,1� ____ E/ (Complete in Duplicate) Date Issueds� 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. JOB ADDRESS AND LOCATION---��---y-- --- ----- v.----Owner's Name----------dlzt -------L.�-R �J,5 ---------------------------------------------------- Phone.....5 1__5` ..... Address Contractor's Name----------------- -------- ------------------------------------------------------------------------------------------------- Phone----------------------------------- Installation will serve: Residence 0-1<partment House ❑ Commercial ❑ Trailer Court ❑ MotelsE]❑ Other i Number of living units: _1_____ Number of bedrooms I---- Number of baths I--- Lot size _______ -_X.1 Ij------------------------- Water Supply: Public system ❑ Community system ❑ Private P—t76'pth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel E] Sandy Loam [-] y Loam E] Clay E] Adobe Ca--HardT n ❑ Previous Application Made: Yes E] No P'_ New Construction: Yes TYPE OF INSTALLATION AND SPECIFICATIONS: W (No septic tank or cesspool permitted if public sewer is available within 200 feet. L& i Se tic Tank: Distance from nearest well_ .' -_- Distance f,�m foundation___ ______-Material_______________________________________________ No. of compartments_____, _:___________/_Size, �y___ :,_ _Liquid depth____S/___________Capacity----—--— , Disposal Field: Distance from nearest w 11 4=0 Distance from foundation___ p � - ,��___ ...Distance to nearest lot line___ - _ Number of lines_____________ ___________ _ __ Length of each line________�j_D_!_______-Width of trench.------ '>-4 t� Type of filter material----(_-�_�t_De th 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--------------------------------- 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 - - 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 r,uhw-4nd reg�rlstions of the San Joaquin Local Health District. (Signed) -------- ------ a---------------- --------------------------------(Owner and/or Contractor) 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----- REVIEWEDBY-------------------------------------------------------------------------------------------------------------------------- DATE BUILDING PERMIT ISSUED-------------------------------------------------- ----------------------------------------- DATE Alterations and/or recommendations---------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ -------------------------------------------------------------------- ------------------------------------ ------------------------------------------------------------------------------------------------------------- --------------------•------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------ -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- FINAL INSPECTION BY: _`_---- Date-------- �/�7 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