14715 - Laserfiche WebLink

Home Browse Search

(FOR OFFICE USE: r ' ..___.____._. APPLICATION FOR SANITATION PERMIT Permit No. _....t......... -------------•-------- (Complete in Duplicate) � (� ') -__..---.-- --------- -- ---- ---- --_.___.._._._ This Permit Expires 1 Year From Date Issued Date Issued `i�........... �_. Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. 8 This application is made in compliance with County O inance No. 54 . JOB ADDRESS A LOC TION --------------------------------------------------------------------------------- Owner's Name- - ----•------ Phone--•................................. Addres5f > ----------------- ----- ------ ......--------------•--s------ ------------•-------•--------------------------------------- Contractor's Name ----------------•-••-----_- --•--.... Pho;A/ ��_ Installation will serve: Residence Ey""'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel Q Other ❑ Number of living units: ._ Number of bedrooms • _ Number of baths ._ -. Lot size -- / •----•____________________••--___--- Water Supply: Public system ❑ Community system ❑ Private Er--Depth to Water Table y/ t. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 2- Hardpan ❑ Previous Application Made: (If yes,date___________________) No New Construction: Yes [�No ❑ FHANA: Yes ❑ No ❑ Y" TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r SF __ptic Tank: Distance from nearest well-l' ______Distance from foundation/Q•__00_--------Material__ __ '... . ........... .. ....... [� No. of compartm nts-._._ _______________Size_ ----------Liquid depth...... Capacity.laQ. Disposal F,Id: Distance from nearest well..--------Distance from foundation_a©_-------Distance to nearest lot line:t; ......... I ❑/ Number of lines------- _____ g `� _____�__ _ __ Length of each line___ __L1__r____.__r`___.Width of trench___.�Y........�......... I' Type of filter material.,,57i - _Depth of filter material-----,f ________Total length...................�?8---•---.----__ Seepage t: Distance to nearest welt/04----------Distancem und -0o ation__ 0_1..___.Distanceito nearest lot line____` 1.1: Number of pits__.../_...--•------Lining material.1 ---..Size: Diameter_.. .. -----.Depth---------07'4••---------•--- � 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):----------------------------------------------------------------------------------------- --------------•-----••--------••-----•----------------------- '1 ........................................... ...........................................•-----_-.------••___.---____-_______----.....-..____............................___.________.__-_____-.. �. ________________ _----------------------------------------- _------------------------------------------------------------------------------------------------------------------------------------------------- I hereby ertif that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, aws, and r s and reg ions of the San Joaquin Local Health District. (Signed)----- --- -- - ------ ----------- ----- -------------- ----- Owner and/or Contractor) y c sy:............ (rttle)---------- -------- ------- (Plat plan, showing size of lot, location of s em in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - - - = = - DATE ---------------------------- REVIEWED Z ------- APPLICATION - -- -- ------- ------ REVIEWED BY.... --••- --------------------- - DATE -----------•---------------- BUILDING PERMIT ISSUED------------------ ---- ---------------------------------------. DATE---•----•-•------------.---------------------- --------- __...... - ---- - ---- -- i2 . - - -. FINAL INSPECTION BY-- --------- --- ------------ --- ------------------------- Date------g _ -J- ------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 134 Sycamore Street 205 West 9th Street ii Stockton,California Lodi,California Manteca,California Tracy,California JES 9 REVISED 6.89 ZM 0-61 ATLAS