10400 - Laserfiche WebLink

Home Browse Search

Permit No. APPLICATION FOR SANITATION PERMIT / (Complete in Duplicate) Date Issued ----- /-S- ' 1 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. v -------------- ------------------ JOB ADDRESS AND LOCATION______.__ _ _ ---- � --- ------ - -- -------------------------------------- --- 1-( �1� --------- ------------------- ----- Phone----•------------------------------- Owner s ame__________ -- -- -------------------- Address-------------- -----------------------SG^-><-.1r- --F-- ------------------------------------------------------ �1 - Phone----------------------------------- Contractor's Name--------------------- �Z----- Installation will serve: Residence �Apar#ment House F1Comrriercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -_l. __ Number of bedrooms -------- Number of baths -------- Lot size ---___-.--______------------------- r Water Supply: Public system [�ommunity system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand [jGravel 171Sandy Loam ElClay Loam E] Clay El Adobe E] Hardpan El Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ PHA/VA: Yes ❑ No ❑ TY F INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) eptic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material_-----_._--_.-----.__--_-_.__.--__._.----.----_. ❑ No. of compartments--------------------------Size-------------------------------Liquid depth,.------------------------Capacity----------------------- LA Disposal Field: Distance from nearest well-_-__-_-----_.._Distance from foundation--------------------Distance to nearest lot line_---__-.._-.----_ ❑ Number of lines-----------------------------------Length of each line-----------------------------.Width of french----------------------------------- Type of filter material-------------------------Depth of filter maferial-----------------------Total length------------------------------------------ Seepage Pit: Distance to nearest well----------------------Distance from foundation-_-___-_--_-._--.-.Distance to nearest lot line___--.-___-___- : ❑ ------ T\ Number of pits------------------ --Lining material_--------------- ------Size: Diameter------------.----------,Dept _._.--.---__-- ----------- Cesspool: Distance from nearest well-----------------Distance from foundation------_-------------Lining material__-.____-----_---__--.--___-___._ ❑ -----.Depth-------------- ------------- ---------------------Liquid Capacity--------------------- - -gals. Size: Diameter____..__________________ Privy: Distance from nearest well___-__.____________________________-.----------Distance from nearest building-----._-_-__-_--_---__-----_---.---_.-.-. El Distance #o'nearest lot line_ ---___ . ��``� -------f` ------ { Remodeling and repair ng (describe:--------_-)- -------------�► - . - ---- 5 c --------------- - -- --------- ----------- -___ - _---------------------------------------------•--------------- &J - I herebaertify that I ham preps d fihis appligation-and that tfre work wih 6e done in accordance with San Joaquin County ordinances, State laws, and ru es and�r-egu ations of the San Joaquin Local Health District. (Signed)- --- --------- --- --------------- ------------------------------- ------------------ (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 �-------------------- REVIEWED BY-------------------------------- ------ DATE--------------------------------------------------- BUILDINGPERMIT ISSUED----------------------------------- -------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations---------------------------- -------------------------------------- --••--------------------------------------- ------ ----- - - Q FINAL INSPECTION BY:-----------------------`s Date-----/___Qi----------------------------- C� 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-4-2M , Revises 1-57 F.P.CO.