10515 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. ., (Complete in Duplicate) ��s#al� Date Issued Application is hereby made to the San Joaquin Local Health District for a perm" -it to construct and inl'the work herein described This application is made in compliance with County Ordinance No, 549, JOB ADDRESS AND LOCA IONL -- --- -- -------- --- -- Ply, ! 2 �_. Owner's Name-- -•----, k --------- ` ---------------- - Phone."•--------- - ---------•------- II_ - Address .. ---- - - I------- -- t"J ------- -- ------ ---------------------------------------- Contractor's Name------- 11 V ------------------------------------------ ------- -------- ---------------------------------------------- Phone----------------------------------- Installation will serve: Residence ;/�partment House ❑` Commercial ❑ Trailer Court El Motel El Other L]Number of living units: ---.(,___ Number of bedrooms ___L. Number of-baths,�__I__..Lot,sixe �,Ic ------------------------ Water Supply: Public system ❑ Community system ❑ Private �epth to Water Table -------- ft. Character of soil to a depth of 3 feet- Sand Gravel ❑ Sandy Loam ❑ Clay Loam E] Clay ❑ rAdobe i Hardpan ❑ Previous Application Made: Yes ❑{ No New Construction: Yes A111rNo ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS. (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic ank: Distance from nearest well-----------------Distance from foundation-,-,--,'------- _.NleteriaL______" -------- ------------------------------ ❑ No. of compartments-----------------! SSiize--------------------- ---------Liquid depth-- --------------------- Capacity--------------4------ ' Dispose Field: Distance from nearest well--- " bistance from foundation---2t--------I---.Distance to nearest lot line_ _05 ' Number of lines__________.__ _Length of each aline------"--- ! '1 �� .= g ��j Width of trench f------------ Type of filter materiS+�E'_t� � �±°____Depth of filter material--------1__S--------Total length_�-----------�_a_1-_______________ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Disfance to merest lot line----------------- ❑ Number of pits----------------------Lining material----------.----- ------Size: Diameter------------- Depth---------------.----------------- Cesspool; Distance from nearest well-----------------Distance from foundation______ Lining material_-----_____________.__.____________. ❑ Size: Diameter---=----------------------------------Depth--------- ---------------nt---------------- -------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building____.____________________________-___---- ❑ Distance to nearest lot line-------------------------------------------------------------------- k Remodeling and/or repairing (describe)--------- ---------------------------------------------------------------------•----------------•------------------------------------ ------------------- I -----------------------------------------------------------`=----------------------------------------------------•---------------------------------I------------------- ----------------------------------------- ----------- --------- ------------------------------------I-----------------------------------------------------------------------------------I--- --------------------•---------------------------------------- I hereby certify that I haveprepared 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 Disfrict. -�------- � (Signed) r t-- --, i--------------------------(Owner and/or Contractor) (Title)_ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., Gari be placed on reverse side). r ; FOR DEPARTMENT USE ONLY . APPLICATION ACCEPTED BY- -------------------------------------------------------------------------- DATE-_- --- --- ---- REVIEWED BY----------------------------- ------------------------------------------------------------------------------ ) DATE_ ------------------------------------------------- BUILDING PERMIT ISSUED-------------------------------------------------------------------------------------------- -- ------DATE-- Alterations and/or recommendafions:-------- -------------------------- -----------------------------------------------------------------• ------------------ -•-------------------------------- --------------------------------------------------------------•----------------------------------------------------------------•----------------------•-------------------•----------•------•---------------•-•-------------- -----------------•---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I. -------------------------------------------------------•---•-- -----------------------------------------------•- --------------------------------------------------------------------------- -------------------------------- ------------------------------------------- -----------------=----------------- -------------- ----------------------------------------------------------------------------------------------------------------------------- FINAL INSPECTION BY:_------.1_f .------------------ Date.--- ----___--- SAN J AQUIN 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 , Revised 1.57 F.P.CO" 1