9704 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. .�..L_-.... __.. q°hl , (Complete in Duplicate) J Date )sued 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 LOC ION__S.-[� N.- [r__C� rdrr ------ Owner's Name-- -_---2 ---------------------------------------------- -------------- Phone--------------------- •-- 12. Address -------------- 1— --------------------- -------------------••--------------- Contractor's Name----------------------------------------14-1-13---n,--- ----------------------------- ---------•--- Phone-------------------- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of iiving units: -------- Number of bedrooms -------- Number of baths I___ Lot size ________________�' -------------•-----------•----------- 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 JW Hardpan [] Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No,X 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__�d�_____-__.Material____-___`_r / ��- ----- ------- No. of compartments----- i-"----------Size_--___?•:-�_!' x_1_iquid depth------- _ .- -----Capacity-•.- Disposa Field: Distance from nearest 'well------_=-Distance from foundation----A-)---------Distance to nearest lot line__-__s�-_ Number of lines--------------/------------------Length of each line------------21,I_______---.Width of french----- ___--Z (,-------••-- Type of filter mate rial-_�-hl----------Depth of filter material--------- -�'__--Total length---------____AS-------,------------- Seepage Pit: Distance to nearest well----------------------Distance from foundation---.___.------------Distance to nearest lot €ine__--_-________.__ ❑ 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 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 Local Health District. R (Signed)------` f .aJJ--th------- - (Owner and/or Contractor) ---------------------------- gY� ----------------------------•------------------------------------------------------------------------------------(Title)--------------------------------------------------------------- (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 ��/ >-K REVIEWED BY -------------. -- DATE BUILDINGPERMIT ISSUED-------------------------------- ------------------------ --- ------------------------------------- DATE----------- ------------------------------------------------ Alterations and/or recommendations:---____._--____________ -------_---- •____-_---____-____- --- -----------------------------------•----------------------------------- ---------------------------------•-------------------------------•-------------•- - ----------------- ---------------------------------------- --------------------------------------------------------------------- ----------------••-------------- -----------•--- ----------------------------•--------------------------------------------------- ----------------•----•- FINAL INSPECTION BY: �:w --1`-� -------------------------------- Date---- � Cs 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--4-2M Revisea 7.57 F.P.CO.