3227 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. ...3 ...7 � (Complete in Duplicate)) Date Issued j''� . . 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 A D LOCA�FN ✓U.' �. ..............- ----------- ----------------- ----- u']L� Y ------- ! 1 . Owner's N e..�11,�-�1-__!_Y_•... -- -------- ----- --------- ----------------- --------- -------------1�---------------------------- Phone------------------------------------ Address... �j-- - ---------------- ----••--•----------------••------------------•---- Contractor's Name---- --------------- --------------------------------------------------------------------------------------------------------------------- Phone--------------------- Installation will serve: Residence F] Apartment House F] Commercial ❑ Trai r Court E] Motel Other t.e- ./ r � Number of living units, umber of bedrooms __ umber baths _ ot size ._�.___._ ____ _� _._.___.____.___.___.__ Water Supply: Public system ❑ Community system C] Private Depth to ater Table ........ ft. Character of soil to a depth of 3 feet: Sad Gravel ❑ Sandy LoamClay Loam Clay Adobe E]Hardpan Previous Application Made: Yes E] No New Construction: Yes [�N ❑ E]o ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 1 Sep^tic�nk: Distance from neare;'well-- Q Dista rye frown fou ration.-.: a------.Mate�r/'a�`_- -- ----- -------- LiT No. of compartments---------_ ____f..__`_Sizesx.�_n __....Liquid depth__._____!'__________Capacity__._ _D--Q___.- Dispos Field: Distance from nearest wellb6''"Distance from foundation �Z Distance to nearest lot line Number of lines__________ _____ ___ _______ _Length of each line--------- Width of trench..__.______�c_ �r ---- ----- ---- Type or' filter materi t_�epth of filter material- Ll-------Total length----------tv-0-- Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line----------------- El Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth----------.-------------------_-- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-----------------------____.________-. ❑ Size: Diameter--------------------------------------Depth-.----- --------•------------------- ------Liquid Capacity----------------------------gals. Privy: Distance from nearest well------------------------------------------------- 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 regulations of the San Joaquin Local Health District. ^R (Signed) - _ _______________Owner and/or Contractor By:----------- ------ ------ ---- --- - ----------- - �"-� "------------------------------------------- +� (Title) --------------------------- (Plot plan, show 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___.____....__..: REVIEWEDBY-------------------_---------- ---- ---------------------------------------------------------------------------------. DATE-- -_ --------------------------------- BUILDING PERMIT ISSUED------------- -------------------------------------------------------------------------------------- DATE-------W-_-------------------------------------------- Alterations and/or recommendations:-___-_.____-_. - - / jy�---------------------------•-------------•--------•------ 0_' --- ---- --- --- - ----•- ...--------- -- - - ,. ----------------------------•------------- --------- --------------------------------- -------------- ............------------------------------------------•-----------------------•------------------------------------ FINAL INSPECTION BY------- --------- -/- ---3t� ,�--------------- 4�_ _...................... 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 y Manteca, California Tracy, California ES-9-2M 10-52 Revised W-2100 ( `'