10524 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued 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. _� . I ` _f JOB ADDRESS AND LOCATION ---------- l -----------------------------------------t----------------------------•----- Owner's Name----------- - ------------------------------------------------- --------------------- Phone_t�_'t - Contractor's Name-----•-_--- Phone Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __/____ Number of bedrooms __�-'_ Number of baths __f_____ Lot size -------l_1` 1t._C.;.%%___________________________ Water Supply: Public system ''Community system ❑ Private ❑ Depth to Water Table ...........ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑'`Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes ❑ No HA/VA: 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_________________Distance from foundation--------------------Material__________-_____________________-_______________- � `; No. of compartments---------- ---------------Size--------------------...........Liquid depth--------------------------Capacity----------------------- Disposal Field: Distance from nearest well_________________Distance from foundation--------------------Distance to nearest lot line_•___-___________ Number of lines------,l--------- Length of each line...... .................Width of trench______ _____________ �.� j-+- Type of filter material___' .:___ ____Depth of filter material- f __-_________Total length-______ 4_r___ s.ti ,^" Seepage Pi#. Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line_________________ ❑ Number of pits______________________Lining material-----------------------Size: Diameter-----------------------Depth-------------________-____________ Cesspool: Distance from nearest well-----------------Distance from foundation----------.---------Lining material_______-______.___-________-_________- v i ❑ Size: Diameter-------------------------.-----------.Depth---------------------------------------------------Liquid Capacity--------•------------------gals. 'r Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------_--------------•__________-_. ❑ Distance to nearest lot line--------------------------------------------------------------------------_------------•--------------------------------------------------- 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- Trrand rules and regulations of the San Joaquin Local Health District. (Signe - `-- _______(Owner and/or Contractor) By:----------------------------------------------------------------------------------------------------------------------------------(Title)---------------------------------------------------------------- (Plot plan, sho\vipg size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). qq FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- JIfj,-6 nn-,-----------------•------------------------------------------ DATE.... �-' � 1-------------------------------- REVIEWEDBY------------------------------------------------------------------- --------------------------------------------------------- DATE------------------•-----------•-•- ----------------------- BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations-----------------------------------------------------------------------=-----------------------------------------------------------------------------------_ ----------------------------------------------------------------------------- ------------------------------------------------------------------------------------•----------------------------------------------------------- -----------------------------------------••-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------ ---------- --- -----------------------------------------------------------------------------------------------------------------------------------------•------------•-- FINAL INSPECTION'BY: �. J =r=" Date--------------Z7 ---------- ------------- SAN -- ------ 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 - Revised 1.57 F.P.CO.