4198 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. 1--.-1...;-.---- ' (Complete in Duplicate) V F-' Date Issued t 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---------------- . ,(!C1 Address---------- -----------------------------&_�_ _4-------/1,).....----�----- -----------------1------------.--------------- Contractor's Name------------------------------------ --- - ------------------- f ------------------------------------------- Phone---------------------.------------- -- - Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: -------- Number of bedrooms -------- Number of baths -------- Lot size ------------------------------------------------------------ Water Supply: Public system orrimunity system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: [Sand E] Gravel El Sandy Loam ❑ Cla Loam#❑ Clay El Adobe ardpar ❑ Previous Application Made: Yes ❑ No ew Construction: Yes o ❑ ; TYPE OF INSTALLATION AND SPECIFICATIONS: I (No septic tank or cesspool permitted if„,p blit sewer is available within 200 feet.) ' !V *-Distance from foun 1-b...___.Materia�_-"- '-------------- Sept_ic Tank: Distance from nearest well---_---- a#�ion-_"-- - ----------- - No. of compartments-------- -- ...Size x - -'--a- Liquid depth ---- J� Capacity Disposal Field: Distance from nearest w €I_ j 'fe`R..Distance from foundation----0f------Distance to nearest lot line""- -"-"- Number o�i lines-----------"-- --.- _ ---Length of each line___--- - -- ---------Width of trench.._-"."- ---_�--------- `'� ��r i I ' Type of filter material'��T --1 --------s Depth of filter material__--.-a ----__--Total length----.------- '---- -------------•-----`� 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------------------------------------- El Size: Diameter-------------- ----------------------Depth------------------------- -------Liquid Capacity- -------------------------gals. Privy: 'Distance from nearest well-------------------------------------------------Distance from nearest building-------------.---_-----_--_------.---- ❑ Distance to nearest lot Iine------------------------------------------------ ---------------------------------------------------------- - Remodeling and/or repairing (describe):------------------ --------------------- --------------------••----------•------------•-------- ----------------------•-------------------------------- -----•-------•---------•------------------------------------•-----••------------------------------- -- -------------------------------------------------------------- •---------------------------------------------------------- --------------- ' ! hereby certify that i have prepared thisapplication and that the work will be done in accordance with San Joaquin Count ordinances, State laws, and rules a regulations of tithe °Joaquin Local Health District. (Signed)..--�----------------_------- --- -------- (Owner and/or Contractor) Title (Plpt plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY----------------------------- --- :------------------•---------------- DATE----------- ---r---- ----------------- REVIEWEDBY---------------------------------------------------------------------- -----------"-------------------- ------ DATE---------------------------------------------------4------- BUILDINGPERMIT ISSUED------- ------ -------•----------------- ------ DATE--------------------------- ------------------------•------- Alterations and/or recommendations:---- ------ - --------------------------------------------------•--••------------------------------------------------------ -------------------------- ----- ---------------------------------------------------------------------------------------------------------------- -------------------------------------- ------------ FINAL INSPECTION BY----------------- - --- --- �w' Date- ---10--- - -------------------------------------- SAN JOAQUIIN 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 10-52 Revised W-2100