9549 - Laserfiche WebLink

Home Browse Search

r�yol APPLICATION FOR SANITATION PERMIT Permit (Complete in Duplicate) Date issued __�*d_l,_�' 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 . OCATION___.a? ---_ _ Owner's Name -- --------------- ----•----- ------------------------------------------------------ Phone------------------------------------ Address--------------- ----•------------------------------Address--------------- -------- -- - ------ - -Contractor's Name------------ -- --- -- ---------------------- Phone------•--------------------------- Installation will serve: Residence Apartment House ❑ Commercial Ej Trailer Court ❑ Motel ❑ Other ❑ Number of living units: J___ Number of bedrooms _Z_ Number of baths __ -_ Lot size _- Water Supply: Public system P-o"Commuriity system ❑ Private ❑ Depth to Water Table A.Z_ ft, Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No Yj"_New Construction: Yes [!fro ❑ FHA/VA: Yes P�-'No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) 00, Septic Tank: Distance from nearest welE------ Distancek frorfouncl tion___0--__--,--Materal______�-------------- ----------- No. of compartments--------a��.�_______.__Size_ srx_4�7_____Liquid depth___ Capacity___ 1911_,. -. F --------------- Disposal Field: Distance from nearest well------ — Distance from found at}pn-Of----------------- Distance to nearest lot line--- [if]� Number of fines_ ____ Length of each line__ _:. ________________Width of trench_._ Type of filter material Depth of filter material__--,� _-.- Yp Total length. ----------------------- Seepage Pit: Dista'rice to nearest well-----------------------Distance from foundation -________-._---__..Distance to nearest lot line___---_______._._ ❑ ;Number of pits------.--------------Lining material---=------------------Size: Diameter-----------------------Dept h------------------------__--- --- Cesspool: Distance from nearest well-----------------Distance from fou ndation-------------------.Lining material___.____-_-----.___._________.______ ❑ Size: Diameter. Depth ---------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well____________________________________--------.-- -Distance from nearest building_________-_---_____________ ❑ Distance-to nearest lot line-----------------------------------------------..........------------------------------ ------------------------------------- ------------- -� Remodeling and/or repairing describe):-- --------- -------------------------------------- -------------- - ---- - - - ------------- ------------------ ---•-----•--------- -- ---- _------------------I------------------------------------------------------------------------------------------------------------------------------ --------------------------------------------------•------•------=--------•---------•-------------••-------------•--------------•------------------------------- - ------------------------------------------------------- ----------------•--------------------------------- --------------------------------•--•---•----------------------------------------•---•----------------------------------------------------------------- -- 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 rules and egulations of the San Joaquin Local Health District. (Signed)----- -%� -- --- ---- -- -------------------------------------Jf2ksvxtr=a*cI&r Contractor) By:--------- ------------------------------------------------------------(Title)_F _ (Plot plan, showing size of lo$ ovation of system in relation to wells, buildings, etc., can be placed on rever siid k f/ j FOR DEPARTMENT USE ONLY i APPLICATION ACCEPTED BY____________ _____ --------------- --------------------------------------------------------- DATE---U2-�--- REVIEWEDBY -----------------------------------------=------------------------ DATE------- ---- � --`�------------------------------------------------ _.._ DATE.---- --•------ ------- BUILDING PERMIT ISSUED Alterations and/or recommendations-----------=----- ----------------------------------------------------------•---------- -------------------------------- ----------------- --------------•---------------------------------------------------------------•--------------------------•---•----- •-•---------•-•---------- --------...------------------------------------- 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 F ES-4-21x1 , Revised 1.57 F,P.CO. r