5083 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No.1_ ZO.A .3... (Complete in Duplicate) I I 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 witjh County Ordinance No. 549. JOB ADDRESS AND LOCATION------- ---1-- ------ GO Owner's Name G -t--- —--- ----d Phone. ..... Address--------------- Z --•----'� `-'(--- _ Contractor's Name------------•---- lc------- -C� ----------------------------------------------•• ---------------- Phone_a?Y..7_�d_r3 Installation will serve: Residence Apartment 'House :El Commercial ❑ Trlailer Court E] Motel F1 Other E]Number of living units: --- --- Number of bedrooms Z,._ Number of baths -1--_.__ Lot size ........3 - .� _ --_-___ Water Supply: Public system ❑ Community system ❑ Private 121 Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe IN Hardpan ❑ Previous Application Made: Yes ❑ No X New Construction: Yes`o No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) /� J Septic Tank: Distance from nearest ell_ '4�S_Distance froms • �foundon_---_l _ v--t-- .Material----_-1-1.ex+-_4/-, No. of com artments_ ---------------Ca acSize___ h----- -t Y Disposal Field: Distance from nearest w 11--- .......Distance from foundation--161, Distance to nearest lot line_--- d---_____ . � 'I 1 z Number of lines______________ ___ Length of each line----______-__ e-) Width oT trench-----____ ±� /-� ----------------- �� \ Type os filter material-_-.5! ' /�acf[Depth of filter material-__--_.- Total length----------------------------------------- ?Q- Seepage Pit: Distance to nearest well---------------------- from foundation--------------------Distance to nearest lot line----------------- /V ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth--------------------------------- [[[[ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-.----_----_-.-.-.-_._---___------_. ❑ Size: Diameter--------------------------------------Dept h_----------------------------------- --------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building--,-----_-----_-__-----_-------_-_------. ❑ Distance to nearest lot line---------------------------------------------------------------------------------------------------------------------------------------------- R odeling nd/or repairinc�#escri ej:------ --- _04.11111 - IQGA ---------•--...-•.---- --- -- / ------------------------------� ------------------••-•-_ --•---------------------•--- -----------------------------------------------------• ---------- •--------------------------------------------•------------------------------------------------------------------------------------------------------------- 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. (Signed). -- -- ------- = -- ------------------------------ _-___(Owner and/or Contractor) By: ----------------------------------------------------------------- ------------------- ---------------------•----------------------(Title)------- --- --- - ----------------- •------------ (Plot plan, showing size of fat, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY /I�� APPLICATION ACCEPTED BY------ - -- - DATE + ' `1� REVIEWED BY --- DATE BUILDING PERMIT ISSUED-------------------------- --------------------------•-----------------•------- ------------- DATE-------•-------------------- Alterations and/or recommendations:----------------------------------------------•-•--------------------•--•----------------------- ---------------------------••--------------------------------------------------------------- ----------------------------------------------------------•--------------------------------------------------------------------- ---------------------------------------------------------- --------• -----------------------------------------------------------------------------------------........... -•------------------------------------------------ -----•-------------•--•------------ ----------••-----------•------------------------------------------------------------------------------------------------------ ---------------------------------------------------------- -----------------------------•-------------------------------------•----------.----- ----------------------------------------------------------------- -------------------.---------------•------------------.---------- ----- ,1 FINAL INSPECTION BY---------------- ----'- ------------- 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-4-2M ; Revised W-2100