4802 - Laserfiche WebLink

Home Browse Search

.1.1 APPLICATION FOR SANITATION PERMIT Permit No. - _ 'V` (Complete in Duplicate) p f -- Date Issued -- Applica*ion 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 ' ante No. 549. JOB ADDRESS AND 7LATION--__- / -- --------- --- ----- --- Owner's Name ----- / t/-Lr '�l' Phone-_ :-a ' Address ---------- ----- -- ------: ,. Contractor's Name - 70-'- -----x ----- ---- -----------•- Phone--- --- --------------- Installation will serve: Residence Apartment House ❑ Commercial [❑ Trailer Court ❑ Motel ❑ Other Number of living units:'_- Number of bedrooms ---- Number Number of maths __/__ Lot size ----- -__.__-.----- -----•----- Water Supply: Public system ommunity system ❑ Private ElDepth_to Water Table -------- if. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe&r0o'Hardpan ❑ v -. Previous Application Made: Yes ❑ No [P�New Construction: Yes P.-<, ❑ 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_��_'C_Disf ce fr m fo ation__140-- Material No, of compartments__--._�_ - Size _ , .. ------ - - ---- ---�-- --Liquid dej.ft --- --- -- Capacity------Disposal Field: Distance from nearest well - istanco fram foundation-- ___ - Distance to nearest lot lineNumber of lines-__- __--.---_ Len th of each line__-g -.Width of trench.-_--- _ Type of filter material-- a- .,__ A, Depth of fiJfer material.------- � --__-Total len th---__--- ------------------ g 6----- 1 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 nearest well-------------------------------------------------Distance from nearest building ❑ Distance to nearest lot line...-__.-____-------------.-_._ --------------- --.------------------------------------- Remodeling and/or repairing (describe):-------------------- ----------•--------•------••---------I-----------------------------------------------------------------------------------I-------------I--------------------------------I--------•- ----------------------------------------- -------------- --�'------------ -••----- - - -- -- ---------------- herebycertify that ! h - - - -- - - - -----"-- - --- ----------------- I y e prepared this application and +hat 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). -� (Pilot 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--------REVIEW ----- _- - ----------------------------- ------------------------------- DATE----------- -- - IS BUILDING PERMIT ISSUED D- -- -- ---------------- ED BY - ------ -------------------- -----. DATE----------------------------------------------------------------- --------------- ----------------------------------------------------------- --------- DATE---------------------- -------------- A terations and/or recommendations.------____.----__--.- - ----------------------------------------•-----------•--------------•----•-----•------------------------- -------------------------------------------- `! f U FINAL INSPECTION BY:. ---— ------------------ Date---------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Sfreet 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised W-2100