9350 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. 31__ie-____. (Complete in Duplicate) %%f Date Issued.___._�.-_C!_..-_ _ Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work;ere-sn described. This application is made in compliance with County Ordinance No. r JOB ADDRESS AND L' C T N_-------- - - ------- __-� ____-- Owner's Name Phon -------------- -------- Address.. ---••--- - ----------------------- - ------ -----------------------------------------------------r 0 Contractor's Name_______________ �- __ Phon � � Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __ Number of bedrooms _C;.Z Number of baths __/� Lot size - --- - --- •------ --•- -------------------- Water Supply: Public system ❑ Community system ❑ Private 2?- epth to Water TableVd- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ Previous Application Made: Yes ❑ No ew Construction: Yes ❑ No A/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: �\ (No septic tank or cesspool permitted if public sewer is available within 200 feet.) S ti k. Distance from nearest well_________________Distance from foundation-------------------Material------------------_------------------------------ r No. of compartments--------------------------Size------------------ -----•-------Liquid de`th--------------------------Capac;fy---------------------- V '� Disposal field: #}istance from nearest well_%5-25'-_ Distance from foundations. __ _.__.Distance to nearest t I-ne__ ------ Number of lines_____________.___ Length of each line__-/.�'V_------------Width of trench. f--____---------- __ Type of filter material._Vr1/ird _Depth of filter materia f------/9__,,_.Total length------ .,� --____..____.__________. Seepage Pit: Distance to nearest well____________________ _ Distance from foundation--------------------Distance to nearest lot line---------______._ El Number of pits----------------------Lining material----------------------.Size: Diameter-----------------------Depth---------------------_------_---- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining mater•sal_____________-_____.________________ ❑ Size: Diameter------------------------ Depth--------------------------------------------------_Liquid Capacity----------------------------gals. Privy: Distance from nearest well______________________________________________Distance from nearest building____-..-__.____________-______.________._. ` ❑ Distance to nearest lot lire-------------------------------------------------------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe}---- --------------------------------- -------------•---------------------------------------------------•------------- -----------------•--------------.--------------------.----------------------------.--------------------------------------------------------------._,-..._.----------------------------------.-------------•------------------ -------------------------------------------- ----------------------------------•--------------------------------------------------------------------------------•-•--•- ---------------------------- - --------- I hereby certif I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State s, a d rules and r guia of the San Joaquin Local Health District. Sined wner and/or{ g (•------------- --------- ----------- ---- ------------------------------------�------------ ----- --•----------- --------------------------- `r f / Contractor) Y� --- ---- �i -----------(Title)--------- E------•--------•----------------------- (Plot plan, showing size of lot, location of system in relation to wells, dings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------------------- - - ----- ----------•---------------------------- DATE--------,.....�--------- REVIEWED BY - DATE----- ------"�� ------------------------- - BUILDING PERMIT ISSUED---------------------------------------- - --- ------------- ---------------------------------- DATE---------- ------ Alterations and/or recommendations: ----------------•--•--- -------- ------ ----•-------------------•----•------------- --------------------------------------------------•----------------------------•---------------- .._.. ... •---------------------------------------------------------------------------- --------------------------------------------------------- ------------------------------------I-----•------------------------. FINAL INSPECTION BY:----- -------------------------------- Date------1 1 ^-_--,- ----------------------------------- jj 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.to-