3198 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. _231 3 l ,�'�`' (Complete in Duplicate) Date Issued ( � �� arid•install the work herein described. Application is hereby made to the San Joaquin Local Health District for a permit to construct This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION------- ------- - ------ - •-------------•-----•------------ --_-__------__--- Owner s Name---------------- _.""-... - Phone -:. - � ------------ --- --------- ---- Address.. ---- - Contractor's Name.--------- -------- -- - - ---- ------------ ----------�...-----•-------------.._ Phone--------------------------------•-- �. Installation will serve: Residence Apartment House Commercial E] Trailer Court L] Motel C] Oth ❑ 7 Number of living units: N er of bedroom ------- Number of baths _/---- Lot size ----- --------------- Wafer Supply: Public system Community system El "Private ❑ Depth to Water Table -------- ft. of soil to a depth of 3 feet: Sand ravel ❑ Sandy Loam ❑ ay Loam ❑ Clay ❑ Adobe Hardpan ❑ � Character p Previous Application Made: Yes F1No New Construction: Yes No ❑ . TYPE OF INSTALLATION AND SPECIFICATIONS- ► (No septic tank or cesspool permitted if public sewer is available within 200 feet.) - ----------------------------------- f Septic Tank: s Distance from nearest well_-__--___---_--_Distance from foundation--------------------Materia-------------------------------------------------- 0 .---_--__ _ ---------------------- ❑�• No. of compartments--------------------------Size--------------------------------Liquid depth-------------------------_Capacity Disposal ield: Distance from nearest well_----___------.-Distance from foundation-____--------------Distance to nearest lot line_--_---_.__- '. ❑ Number of lines-----------------------------------Length of each line_------------------_----------Width of trench-------.-------- ------------------ Type of filter material_____- ____--- Depth of filter material--_-__-_--------------Total length----.._:---------------------------------- Seepage Pi Distance to nearest well_- 9� __- -_ Distant oiandaV n Dista"ce to nearest lot ine_. .-_____ De th----- 3 Number of pits___ !1 ---Lining material �,� e: Diameter._- ------------ - p Cesspool: Distance from nearest well-----------------Distance from foundation-------------____--Lining material---___-_.--_-._----_-__---------els. ❑ Size: Diameter--------------------------------------Depth--------------------- Liquid Capacity---------------------------g __�'__- *"` .=Distance from nearest building- Priv - - • Distance from nearest w`ell-------- -- C ❑ Distance to nearest lot line---------------------------— - r fRemodeling and/or repairing (describe):--------------------------------------- ----------- ---- -------------- --------- ------•-------------------='---- -----------------•-------- ------ ----------------- ------------------------------•-----------------------•------- - - ---- -------------------------------------------------- - - I hereby certify that I have prepared this application and,+hat the work will be done in accordance with"San Joaquin County ordinances, State laws, and rules and regulations of the San' oaquin Local Health District. Si nod #- - �' � ---_ [Own nd/or 4aatorl (Signed) /j(/�J t "� fk ----5------ -- ---------s--- --- '•- - --- ' -- -- --- ------ (Title) ------- -- ---------------- - 6 By. buildings, etc., can be placed on reverse side). (Plot plan, showing size of lot, location of system in relation to wells, FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------------------------- ----------------------------------------------- DATE------------ _ _ o---'=-------------- REVIEWED BY---------------------------- ------------------------ --- ---------------- - ----------------------------------- ----------- DATE------------ -------------------------------------------- - - - BUILDING PERMIT ISSUED------------------------ -- --- - DATE-------------------------------------------------------------- Alterations and/or recommendations----------------------- --------------------------------------------------------------------------- --------------------------------------------------- ---------------------- ---------------- ------------- ----------------------------------------------------------------------------------------------- ---------- ---------------- - --------------- ------------------------------------------------------------------------------------------------------------- FINAL INSPECTION BY:---- = f1 --------- Date----!_------ --r-----------�----------------------------------------------- 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 P f t Es-9-2M 8-51 Revised W-2100 -n.- -