11308 - Laserfiche WebLink

Home Browse Search

�a1 APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) c� Date Issued J7 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 o. 549. p JOB ADDRESS AND LO TION------- _---6-- --- 41 Owner's Name �,---- ------------ Phone - ----------------------------------- -- Address----------- 14/ + - ------------- Contractor's Name ---- ,. 4f Phone = ---------------------------------- Installation will serve: Residence ❑ Apartment House Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -`. -- Number of bedrooms _:�,.- Number of baths ---%L- Lot size ---2.vop __"__ Water Supply: Public system Community system ❑ Private p Depth to Water Table _Y�ft. Character of soil to a depth of 3 fee+:' Sand ❑ Gravel ❑ Sandy Loam ❑ Clay_ Loam ❑ Clay ❑ Adobe ® Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ FHA/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----7-------.-__.Distance to nearest lot line--zi-,, _- Number of lines------------f----------------------Length of each line----------- ------------Width of trench-� __ Type of filter material------%V --.----J.--Depth of filter material---A .. ------_._Total length--_. d------------------- --- Seepage Pit: Distance to nearest well-- ""` ------Distance from foundation - - --------------Distance to nearest lot line-__-2.r ___ ® Number of pits.--_-1---------------Lining material---:�A_(--------Size: Diameter- _3 -/� -- - --------- Depth------ ---------------- - Cesspool: Distance from nearesf well-------------_--Distance from foundation--------------------Lining material-____ ____--- ❑ Size: Diameter-------------------------------------Depth------ --------------------- ---------------------.-Liquid Capacity----------------------------gals. -� Privy: Distance from nearest well------------- --------------------- --.----Distance from nearest building ------------ Distance to nearest lot line---------------------------- ------------------------------------------ Remodeling and/or repairing (describe)------------------------- f ---------------------------------- ----- ----------------- ----- ------------------------ -- ----------------------------------------------------------------- ----------------------------------- -------------------------------------------.—-------------------- ------------------- 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 ocal Health District, i Si nedO� r ( 9 ) pp /J ----------------------- y" .-------------------------------------(Owner and/or Contractor) Sy:-------------------- ------------ -- -- ______ ------ --------- -------------------------(Title)------©c`-'y`�tr----- ----------- ------- - (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----------- I ----- REVIEWED BY ------------- DATE---------- _ 1 BUILDING PERMIT ISSUED - - DATE ; A terations and/or recommendations:_ -------------------------t' 1 -------�`T NJ �-•-------- t -- �,_ _,n'9 -•-•----------I� �----••---------•-------- - - FINAL INSP '-- . - r ------ Date------ 7---------------- - 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.