5530 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. .v�". �,--,--- " _ (Complete in Duplicate) c._ 3 " Date lssued ,, - Applicatioeis hereby made to the San Joaquin Local Health District This application is made in compliance with County Ordinance No549r a permit to construct and install the work herein described. JOB ADDRESS AND LOC TION14.0 ,tom l j/ wner's Name------ --------- Phone Address ' --I--- Contractor's --�Name____________________ p artment House E] Commercial - --------------------------------------------- "----"---"- -•_ --- ------" - ""----"-"- Phone_ Installation will serve: Residence A _"-._--- "--_-__--""----""_--- ❑ Trailer Court ❑ Moel ❑ Other ❑ Number of living units:!_____ Number of bedrooms S--- Number of baths I__- Lot size _4px — ----_----- Water Supply: Public system • Community system �d/� Pp y' � Y Y ❑ Private ❑ Depth to Water Table D__�p ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel E] Sandy Loam J1 Clay Loam ❑ Clay [) Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No JR New Construction: Yes Q No ❑ 14 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,foun�tion___�:�._-----Mat rial -►- _ No. of compartments_ "-� F-------------Size.... - - - Liquid depth___ ----Capacity--- Disposal Field: Distance from nearest w lf...___________ _ �" �- Distance from foundation__./.,'>____-._._. Distance to nearest lot line_____ Number of lines-__._"__ Length of each line_ � O . o .� -�-•-- -�� -- _-, Q.S�---Width of trench-.----��------. Type of filter material_- JI �. _. Depth of filter material-------f-.Q" "-----Total length-------,�1,�"Qi--- ----------"-"--- C Seepage Pit: Distance to nearest well----------------"_----Distance from foundation-------------.------Dstance to nearest lot line ______ ❑ Number of Pits----------------------Lining material______-----" --- ---- -Size: Diameter------------------------Depth----------------------- -------�• "� Cesspool: Distance from nearest well-----------------Distance from foundation-------------------_Lining material---------------------------------- - S 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. `OQJ (Signed)-----• r% 09 v -------------------------- ---------------(Owner and/or Contractor) By:---------------------------------- Title (Plot plan, showing size of lot, loca+ion of system in relation to wells, buildings, etc., can be placed on reverse side). O ART T USE NLY APPLICATION ACCEPTED BY--------------- __ DATE----- _ . . VIEWED BY ------- ------------- - UILDING PERMIT ISSUED------------------- DATE - ----------- ---------- ------- DATE.._.---------------------- -- ------------ Alterations and/or recommendations:---------- ---------------------------------------------------------------------------- ____"__._.____" ----------------------- FINAL INSPECTION BY:. ,� ._ .-- -_--_ Date y 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 +0"52 Revised W-2100