8378 - Laserfiche WebLink

Home Browse Search

Permit No. ._•� " APPLICATION FL_ SANITATION PERMIT `1yV1 [Complete in Duplicatel Date Issued .1-- - "--1- —Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. f is application is made in compliance with County Ordinance No. 49. I 'JOB ADDRESS AND CATION ------- --- ------ .� IOwner's Name-___ I ------------ ------------ --- Phone ---• ----•--- , ------------------------------------- ---------------- Address ------•--------------------- • -- , --- ------ y Phone- -- —�� / Contractor's Name------- ------ - ------------------------ ------ Installation will serve: Residence Apa meet House ❑ Commercial ❑ Trailer Court ❑ Motel Other �Q---•------------------------ '� Number of I-suing units j: _- -- Number of bedrooms _ Number of baths ._�-__ Lot size __��-�------ 'M Private Depth to Water Table ft. • Water Supply: Public system Community system ❑ ❑ P Character of soil to a depth'lof 3 feet: Sand E] Gravel ❑ Sandy Loam [IClay Loam ❑ Clay ElAclobox Hardpan ❑ i Previous Application Made:1IYes El No New Construction; Yes No E] 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-------------------MateriaL--------------_----.__-----_-----.___-----._---. No. of compartments------------------------- Size-------------------------------Liquid depth Capacity j Il Disposal eld: Distance from nearest well__-.-._--- - Distance from foundation--------------------Distance to nearest lot line----------------- ' each line------------------------- Width of trench.---------------------------------- Nb ',!oi lines - Len [ filter mh of aterial-----------------------'-Depth of filter. material-----------.- -- .---Total length-----------------------------•------------ 7Type ofP " +- E Distance from undationDistance to nearest lot ling---_,�--.--- Seepage Pit: Distance to nearest well �9" =pepth___---. J� ry Linin mafierial Size: Dia eter__, - r. Number of pits --------- -- g "V r Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material--------_----.--------------------- ------------ --------------- els. -Liquid Capacity--------------------- -----g �R Size: Diameter--------------------------------------Depth--------------------•------•----------- �1J ❑ ------DfstanCe from nearest building---------------------------------------... Distancl -rivy: Distance from nearest well_-------------------------- e to nearest lot line ------- --- - I Remodeling a /or repairing (describe:-_--_.- - ------- ---/--------------- -------- 9 ---------------- y 1-----•--•----- • ----------------------•--------------------------------------------------------------•-----•----------------------------------- I hereby certify that I;have )repared this application and that the work will be done in accordance with San Joaquin County ----- -------- ---- ---------------------------- ------------------------------- p p PP ordinances, State laws, and rules andlregulations of tife San oaquin acal Health District. ,;. '� ' - . ------------- (Signed) (Ow @r /or Contractor) ---- ---jTitle .rte --- -------- gY� - [Plot plan, showing s of lot, to ation of system in relation to wells, buildings, etc., can be"I ced on reve>s4die). � FOR DEPARTMENT USE ONLY DATE-------------------------- ---------1----------------- APPLICATIONACCEPTED BY--------------------------- ---- -------- ---- -------------------------- ---- ---- ---- r ii -4 - DATE " = ----------------- REVIEWEDBY------------------------------- ----------- BUILDING PERMIT ISSUED:-------------•---------- -----------•---------•---------------------------------------- DATE-----.-------------------- Al+erations a /or recom tendat' ------------------ 4 s -� = ----------- 1 - .-s ----- ------------- - --------------------------------------------------------------------------------------- "� r.1NAL INSPECTION BY Date--J ---- SAN JOAQUIN LOCAL HEALTH DISTRICT 132 Sycamore Street 814 North "C" Street 130 South American Street 300 West Oak Street y Tracy, California Stockton, California Lodi, California Manteca, California ES-9-2M i0-52 Revised W,`2100