9922 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. ._ ! ---- -- -.._ .. r ' (Complete in Duplicate) 11 Date Issued' ssued __ 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 LOCATION------------ Owners Name___________________ ------ -------------� t�s � --------*------ --- ---------------------------------------- Phone------------------------------------ Address------------------------------ Contractor's Name � -. phone- -------------- -- -- � _Jr4-Q Installation will serve: Residence'X esidence.X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [] Other ❑ Number of living units: ----/_ Number of bedrooms ,Z___ Number of baths _f_____ Lot size _____ -__-___ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table 30_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel [] Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [ Hardpan ❑ Previous Application Made: Yes ❑ No X New Construction: Yes ❑ No 14_ FHA/VA: Yes ❑ Nol TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r '� Se tic Tank: Distance from nearest well--- from foundation_-_ --------Ma _____________________ A, No. of compartments-------------al----------Size--------4�.Z-- --Liquid----.---_ Li de th----- - q p ,Z?/Y--------------Capacity----��_ Disposal Field: Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line_________________ ❑ Number of lines----------------------------------Length of each line------------------------------Width of trench Seepage Pit: ----------------_-- ---------------- Type of filter material-------------------------Depth of filter material-----------------------Total length------------------------------------------ \ Distance to nearest well from foundation to nearest lot line____-__________._ ❑ Number of pits----------------------Lining material--,--------------------Size: Diameter-----------------------Depth----------------------------,---- Cesspool: Distance from nearest well----------------- from foundation--------------------Lining material-------------------------------------- El 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}: ----- ---- --------- 3r' --------1�---•�s-------- _- 5--------- - - ------------- -•------------------------------•---------------------------------------------------- ----------------------------------------------- ------------ -------------------• -- 11_1p ,-�------------- ------------------------• ----------------------------------------------------------------------------------------------------------------------------------------- - 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 rues and regul 'on of the San Joaquin Local Health District. (Signed)_._ - -----(Owner and/or --- r--- --- --- -- -- - - ----- -- --- -- ----------- ------------- -- contractor) By: -------------------------------------------(Title)---- rte_.. ------ (Plot plan, showing size of lot, location of system in relat' to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONI Y APPLICATION ACCEPTED BY7 DATE--r------------------- REVIEWED BY------------------------------V - ------------------------------- ----------------------------------- DATE--�} --------------------------------- BUILDING PERMIT ISSUED------------R----------- - ------------=-------------------------------------------------------• DATE------- ---------------------------------------------- Alterations and/or recommendations------------------ -----------------------------------•-------------------------------- -----•----- �------------------------------- ------------------------------------- ----------------------------------------------------- -------------------------------- •---------------•---------------------------------------------- FINAL INSPECTION BY---------------------------------------------------------------- Date---- - - --- --------------------------------------------- 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 , Revisea 1.57 F.P.CO.