3437 - Laserfiche WebLink

Home Browse Search

3 Permit No. 3 7 APPLICATION FOR SANITATION PERMIT _ (Complete in Duplicate) s 5 1Y Date Issued Application is hereby made to the San Joaquin Local Health Dist ri r a permit to con s+ uct and install the work herein described. This application is made in compliance with County Ordinance 9. f i�� - -- JOB ADDRESS AND LOCATION.. `f .... _ Name----------------------------------------- ---- ------------- ------ -•--- ----- Phone__-�_ -��---------------- Owner's Address-----------------------------------------------------------�-�-��--- ------ - ----- ----- - • - ----- ------------------------------------------------ - � _ - Phone-----9:!n Contractor's Name-----------•-•-------•-•-----•- - --------•----- •------------------ - --- Installation will serve: Residence [�Apartment House ❑ Commercial ❑ Trailer Court ❑ /Motel ❑ Other ❑ Number of living units: __I-___ Number of bedrooms � Number of baths _1__- Lot size ----- ---------------------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table ------- ft. f Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay m ❑ Clay ❑ Adobe LK_ Hardpan ❑ Previous Application Made: Yes ❑ No;F!9- New Construction: Yes-E] ' No ❑ ,c,r TYPE OF INSTALLATION AND SPECIFICATIONS: # (No septic tank or cesspool permitted if public sewer is available within 200 feet.) i! S is ank: Distance from nearest well-----------------Distance from foundation--------------------Material __.----------.__--4'__----_______________._._-. No. of compartments. -Size--------------------` t1�- Liquid depth------- ------- ----------ap•�Ity---------------------- . . iii fir+_- r p al Field: Distance from nearest well"- d___._.._.Distance from foundation--- to nearesf lot line___�____- D os Number of lines------ ----_-i rr " Length of each line--- a+<��------�� Width of trend h----�2r�-------------------- __Total length--- `-------------------- Type of filter_matenaL_" _`IIS_- -----Depth of filter material___._ �-._____ t 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_._.__""_____ti`_..Lining material_...___._i-------------------------- F1 -Size: Diameter-------------------------------------Depth_----------------------------- ............ Liquid Capaci�Y gals. Privy: Distance from nearest well----------_------------------- �-=Distance from nearest building_._----------'______-- --__ ❑ Distance to nearest lot line------------------------------------------------ ------------------------ ---------------- ----------=--------------- ----- --. /I _ - __ _ I I Remodeling and/or repairing Idescribe):--------- ---------------------- ----------------------------------- -------------------------------------- Il � ---------•--------"---------------------------------------------- ------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------- -- ------------------------------------------•----------------------------------------------------------------------------------------------- I hereby c r ify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St to laws, and r les and regulations of the San Joaquin Local Health District. x ± (Signed]---___-•- [�r Contractor] - 1 --------------- By: -- ------------- - ---------- (Title) 01�/ (Plot plan, showing size of lot, location of system in re)ion to wells, uildin s, etc., can be placed on reverse side]. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------------- ------ �C �- '°--------------- DATE ,:; i �'---------------------------------- - ----- DATE REVIEWED B -- - ----�------- ------------- ---------- -• ---- BUILDINGPERMIT ISSUED-------------------- -------------------------------------------------------- DATE-------------------------------------------------- --------- Alterations and/or recommendations---------------------- - -------•---------•------------------------------------•--- -------•----------------------•-•------------_----------------- ' ---------------------- ---------------------------------------------------------- ---------- ------------------------------------------ ------------- -------- ----- 7 r ---------- --------------------------------•---- Date ` `= .J FINAL INSPECTION BY-- -------------- ��/J----- 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 9 2M 10-52 Revised W-2100