2953 - Laserfiche WebLink

Home Browse Search

Y Z APPLICATION FOR SANITATION PERMIT Permit No. \\ (Complete in Duplicate) �t �� \ -Date Issued __f__?-- 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 Or ' ance No. 549. JOB ADDRESS AND LOCATION_____l___A_ '..?p _It........_ T, :_f _ _ L 1 �( Owner's Name------•- -- w�_!_l7!i R •----tiAA� ---- Address------------------------------------ ------ -------------- - - -------- -------- Contractor's Name---------------- 7 ------------- Phone---------------------------------- Installation ---------- -Installation will serve: Residence X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of livingunits: ________ Number of bedrooms ________l __ _ ...___________ _________ .,3__ Number of baths _ _____ Lot size Water Supply: Public system ❑ Community system ❑ Private j Depth to Water Table __:.__- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑, Clay E] Adobe g Hardpan ❑ Previous Application Made: Yes ❑ No ® New Construction: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: _. (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well--6-0-------Distance frDm fo ndation .�?---------Materi I No, of compartments--------------'-------Size--- -------Liquid depth_.__.•____ ___________Capacity--------F!�d.___ Disposal Field: Distance from nearest welL_..f ___Distance from foundation_--__ ._.....Distance t nearest lot line_______v�__�__- Number of lines._ -___ 3_______ Length of each line--------------- __________.Width of tren _ _-----�-` , Type of filter material_I�__.Depth of filter material____-___-IS--___.___Total length______ _________,7YQ_--------------- Seepage -._ _--_Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line................. ❑ Number of pits_____________________Lining material-----------------------Size: Diameter---•--------------------Depth---. ---------------------------- Cesspool: ____ _-____-_- ____-_-__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 _____-__Distance to nearest lot line------------------- -------------------------------------------------------------------------------------------------------------------- Remodeling ----------------------------- --------------------Remodeling and/or repairing (describe): ----- -------- •------- •------------------------------------------ --•----- --------. ---------------------------------•.._..--•------------•------------------------------------------------------•------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------- --------- --------------------------------- -------------------------------- -------- ---------------------- --------- ------------------- 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. (Signed) _ ----- (Owner and/or Contractor) By: ------------------ ------(Title)--- •------ (Plot plan, showing size o lo�Iaflion of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-----•_______ ________ _ _ _ DATE -----_---- ------------- {? BY_ _________•___ _ DATE------------------------------------------------------- REVIEWED � �r ------------------------- BUILDING PERMIT ISSUED..................................----- ---------- ----- -------- -•--• DATE -•----...••. -•------•-----•-------------•--------•---•- Alterations and/or recommendations:------------------------------------------------ --------------------•-- ---•---- -- -----•-•-------•----------•••-------•'----- ---------- -%------- ------ ------------------------------- PJ � FINAL INSPECTION BY:.......... - Date----------r�b ------------------------ 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-9-2M 8-51 Re III'W-2100