2067 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT _ Permit No. -_,�-avl....._ . (Complete in Duplicate) 4- % Date Issued _. f'S Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein describeeefti,` This application is made in compliance with County Ordinance No. 549. b { JOB ADDRESS AND LOCA N_____________------ U_- ------------ ' , -- ----- -------------------- Owner's Name ------------------------------------ Phone Address------------------- r ---------------------------------------------------------------- ---------- i j Contractor's Name------------- --- Phone ------ ------------- ----------------------------- ---------- Installation will serve: Residence A artment House Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms _/-___ Number of baths __!_._ Lot size Water Supply: Public system ❑ Community system ❑ Private epth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe -� Previous Application Made: Yes ❑ No (tom'-"New Construction: Yes TYPE OF INSTALLATION AND SPECIFICATIONS: 41 t (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r � Septic Tank: - Distance from nearest well___. _ Distance,4rom foundation_.'4:L�__,____-Material._ ------ ----- Noof compartments_ ---------------Size.___.X ~______ ____Capacity. __ .�S.�j Liquid depth Disposal Field: Distance from nearest well J-4./-----__Distance from-foundation__ ai__G�_:_____Distance to nearest lot'/line__ _-__--Alilto . Number of lines___________,--------------------Length of each line---------- D_--____.-Width of trench___ �T' 1 -------------------- X Type of filter material____ Depth of filter material._. _ g ��` - �. --- --- -----Tptal length D--------- ------- --- Seepage Pit: Distance to nearest well_ _ ____ ______Distance from foundation--------------------Distance to nearest lot line----------------_ `� j ❑ Number of pits---------------:- _. Lining material-----------------------Size: Diameter______ ___ ----.Depth------------------------- ---- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining materia-------------------------------------- Size: ❑ Diameter--------------------------------------Depth----------- - ------ ---------------Liquid Capacity- ------- - -- ----------------------- Privy: Distance from nearest well__ _ _____ ___ ______ _______Distance from nearest building ------------------------------------------- Remodeling ---- -------------------- ----- ❑ Distance to nearest lot line_ ________ G: Remodeling and/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 les and regulat' sof the San Joaquin Local Health District. U i (Signed)_ ----------------------------------------------------------(Owner and/or Contracta4 BY: ------------ --------- . . Title - - --- ----------------- ----------------------------------- ----- ( � ) ---- --- } (blot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). zy FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_ ------------ / REVIEWED BY. - ----------------------------------------- ----- DATE--- -,� . f --- - --- - ---- ---- - DATE ________________ _y_ BUILDING PERMIT ISSUED-------•---• •-• -- ._-.-_-.-_------------- , ------------------- ------------------------------ T -------- IrAlterations and/or recommendatio s•---- 0-"4— _.A - ------ ------------- ___ ___ ------------ .._'.f=.____. ____O'\. _ .__.___ f ---------------- -.......... '�_��- �k 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 9-2M 8-51 Revised W-2100