2474 - Laserfiche WebLink

Home Browse Search

£APPLICATION FOR .SANITATION PERMIT Permit No _7-._`___ (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. JOB ADDRESS AND LOCATIO ------'_______✓__ __-_d�_.___4Sc___ _�_______ Owner's Name---------------- r- •--------------------- �. ---------------------------------------- Phone --------------------------------- Address ------------------ - z Address = ------------------------------•--------------------------------- Contractor's Name--- 6--t-4 ------------------------------------------------------------------------------------------------- Phone------------------•---------------- - Installation will serve: Residence X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -__1___ Number of bedrooms -- - Number of baths ___L_ Lot size --- 2._e ,..e-____________________________ Water Supply: ' Public system ❑ Community system ❑ Private Depth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel p Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ Nox New Construction: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank'or cesspool permitted if public seer is available within 200 feet.) Septic Tank: Distance from nearest well------L -ODistafrom fours ation-----�O---_..M terial---- - ---- ----,--- No. of compartments----------Z-------lSize_° '__x__ __ -- ----Liquid depth,__7""__________________Capacity---�—S_ Disposal Field: Distance from nearest well----I_51?...Distance from foundation____A� ____Distance to nearest lot line____6________ Number of lines_________ _____ __ Length of each line______ - .W ,,� _tt____ dth of trench------ --------- Type of filter materij� -,-a- _Depth of filter material_______ _ ________Total length------f ._0-_ Seepage Pit: 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____________---___--_________________- ❑ Size: Diameter-------------------------------------Depth-------------------------- -- ----------------------Liquid 'Capacity----------------------------gals. "—Privy— :` -Distance-from_near_ez-r el1----------------------- ----------------------Distance from nearest building----------------------------------------- Distance to nearest lot lisle-----------------------------------_------- -- �- �-•�-_�-- .-— . . { Remodeling and/or repairing {describe}:--------74elewlr ---------------------------------------------- ---------------------------------------------------------------e------••------•--------r--�--------------------------------------------------------------------------------------------------------------------------- - I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Count ordinances, State laws, and rules and'regulations of the San Joaquin Local Health District. (Signed)_- � - _ � -------------------------- --------------------------------------(Owner and/or Contractor) -------------------- By:--------------------------------- ---- -----------_- ((Title)-------------- a_ (Plot plan, showing 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------ '' �'� 7 - REVIEWEDBY---------------------------------------------------------------------------------------------------------------------------------------------------------------------- DATE BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------------- _---- r Alterations and/or recommendations:------- "__-`, r�° ------------------ WT-:------_-_-- ----_- ---•--A---- --- ------------- _ - - - - -------------------- _-- ---------- ------' ------ ---- FINAL INSPECTION BY------------- L---,3--------------------- ----------------- Date-------------------- '2J3-- ------------------------- SAN JOAQUIWLOCAL 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 Revised W-2100