4487 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. _.....4 (Complete in Duplicate) Date Issued ... Vvpplication 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 LOCATION...--- ----- - _ Owner's Name------------------------ Yom._ one---3--Y .7_- ' _ Address •: - -i�- t'. Contractor's {lame----------------------------------------------------------------------------- ---------- ------------------------------------------------ Phone................................... Installation-will serve: Residence 1K Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _1____ Number of bedrooms _4— Number of baths ._l-_- Lot size .... '��'__�.� Water Supply: Public system X 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 IN Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes X No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if pu lic sewer is available within 200 feet.) i Septic Tank: Distance from nearest well...�YA '_Distan from f oun 1on----JO_W*xMateri�l---- : _ -_ _---_-___. No. of compartments______.- __-__.___-_Size_.3--eXi Liquid depth_.--_'j�______________Capacity--- --I-....._ Disposal Field: Distance from nearest well-.-- Distance from foundation.ld._jam_--.Distance to nearest lot line_ __.__ _.. INNumber of lines..........*..-: ._ _ Length of each line.......... Q------------Width of -- trench-_____-_'.�_�TYpe of filter material. Depth of filter material ------Total length Ole Seepage Pit: Distance to nearest well---------------------- 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-------------------------------------- Size: _ -__:__- _-_--_:_____-- Size: Diameter--------------------------------------Deth-----._.-_-----------------------------------------Liquid Capacity ---------------------gals. Privy: Distance from nearest well___------_---------------------------------------Distance from nearest building------------------------------------------ F1 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, Stat aws, d ule .gpd regulations of the San Joaquin Local Health District. (Signed)---------- - -- ---- Z....� -----------------------------------(Owner and/or Contractor) ey:. - --------------------------------------------------------------------------- (rte) (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEP ENT USE ONLY oe APPLICATION ACCEPTED BY---------- --- --- - * -------------------------------------------- DATE-------- REVIEWEDBY---------------------------------------------------------------------------------------------------------------------------- DATE---------------------------------....... ------------------ BUILDING PERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE--------------------------------------- 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 ES-9-2M 10-52 Revised W-2100