3161 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No.�_/__` _/ (Complete in Duplicate) h Date Issued _.______-__��'u�'A— App lication 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---------------- --_ Owner's Name--------- ---------------------- --- Phone------------------------------------ Address -----•---------------------------------------- ..- ----------------------------------------------------------------------------------------------------------------- Contractor's Name _ ---------- --------------------------------------------------------- Phone----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living. units: ________ Number of bedrooms __ Number of baths ,� Lot size ______ �_ �__- ✓�•P ..________ -_ Water Supply: Public system ❑. Community system '[] Private ❑" Depth to Water Table -------- ft. ' Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam 0 Clay ❑ Ado b Hardpan ❑ Previous Appiica+ion Made: Yes ❑ NojK. New Construction: YesK No ❑ '� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest wel___ .O------Distance from found ion_____/_d_.______.Materlal--_ No. of compartments_-_---- -------------Size_-_--- ( � _____Liquid depth-----_--4 ° _Capacity---- d Dis osal Field: Distance from nearest well__�4 ...__Distance from founclatien___ 4--f------.Distance to nearest lot f Number of lines____________ ---------_-._Length of each line-_---___�__C�__{r_-_-__Width of trench---____-_---q-_------�____ Type of filter material-� -_-��,Depth of filter material___--___C __Total length--------------------- --------- d Seepage Pit: Distance to nearest well------- -------------Distance from foundation--------------------Distance to nearest lot line__.___-----__--_ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth--------------------------------- Cesspool: Distance from nearest well_________________Distance from foundation-------------------.Lining material-------------------------------------- ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals, Privy: Distance from nearest well--------------------------------------------------Distance from nearest building------------------------------------------ Distance -.___----________-_----_____--..-_-----.Distance to:-nearest lot line------- --------------------------------------- --------- Remodeling -------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, tate laws, and rules and regulations of the San Joaquin Local Health District. f {Signed - -- ! I i -----------------------------------------------------------------------------(Owner and/or Contractor) ! By:-----------------------------------------------------------------------------------------------------------------------------------(Title)------------------ -------------------------------------------- • , (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCFPTED BY--------------------------------- ------------=-----------------=------------------------------- DATE REVIEWEDBY----------------------------------------- --- -- - -------------------- --------------------------------------- DATE----- BU1LDi•NG PERMIT ISSUED-------------------- - ------------------ ------------------------------------------------------- DATE ------------------------- Alterations and/orrtFcomm'endati-o'ns=:. ------------f------ ` ` T. , -- ' ��--------------- -----= `t " ---------t --- -- ----- ------')------------------- - - r e, t --- - -- - FINAL INSPECTION BY______________ ____ ___ _ -------------------------------- yy J - Date----------- -l-1-- ---�-� -- -� -------------------- --------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 SOUfh"American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California `` ES-9-2M 8-51 Revised W-2100