4039 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. . d - (Complete in Duplicated VE Date Issued _[IiY� ""--- 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. 7 6? JOB ADDRESS AND LOCATION....c2_9 -./------- - Owner's Name_______.__16"_._`..___ -• �--------- �®��--�� ------ ----------------------------- ------------ Phone----- --------------------------- Address ...F-3.7_.----- = -- -------- Contractor's Name__._ Phone- Installation will serve: Residence�partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __l___ Number of bedrooms _- Number of baths _/. "p --- Lot size ---e_a X _ ---------------------- Water Supply: Public system ommunity system ❑ Private ❑ Depth to Water Table ---'L/j ft. Character of soil to a depth of 3 feet: Sand [] Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay 0 Adobe [q—ITardpan ❑ Previous Application Made: Yes [] No 6--New Construction: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic 7a4: Distance from nearest well_________________Distance from foundation--------------------Material________.__ •e1/'9t/ No. of compartments--------------------------Size--------------------------------Liquid depth-------------------------Capacit --- Disposal Field: Distance from nearest well_________________Distance from foundation--------------------Distance to nearest lot line----.-------_____- Number of lines-----------------------------------Length of each line------------------------------Width oftrench.---------- ---------------" N -------- Type of filter material___________"_______"_____Depth of filter material-----------------------Total length.----------------------------------------- Seepage Pit: Distance to nearest well----------------------Distance from foundation--.-? ....... Distance to nearest lot line....Number of pits-------/-----------Lining material_ -44 Size: Diameter---,2`..........Depth---2�f"_-------------------- Cesspool: Distance from nearest weft-----------------Distance from foundation--------------------Lining material__.._"_______..____ Size: Diameter Depth L---------------------------------- - ------Liquid Capacity ----------------------- gals. Privy: Distance from nearest well-----------------------------------------------.-Distance from nearest buildin El 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 .ioaquin County ordinances, Sta laws, and rules and regula 'ons of the San Joaquin Local Health District. t -------- --- - -------- ----- - ---- -------- -------------------------------------------- <#Aarnei vii-nd!ftr Contractor) lay:. ------ Gux -- --------------------------------------------------------- -----------(Title)-------------- - --- --------------------- (Piot 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 ACCEPTED BY------------- -------------------------------- ----��---------------------------------- DATE--- -------- REVIEWED BYiS - ------------------------- --------------------------------------------- DATE------------ BUILDING PERMIT ISSUED-------------------•--------------"---------•--- ----------------------------------- DATE---- --- ---------- ----------------------------------"--""A terations and/or recommendations:----------------------------- ---------------------------------------------------- -------------- -------------------------------------------------------------------- ---------------------- ------------ FINAL INSPECTION BY_____________ / D !�� Date SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Sfree+ Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 10.52 Revised W-2100