3005 - Laserfiche WebLink

Home Browse Search

i yJJ PPLICATION FOR SANITATION PERMIT Permit No. 0_Q- _---- `2 (Complete in Duplicate) Date Issued F------------------ Application is hereby made to the San'Joaquin Local Health District for a permit to construct and install the work Herein described. ' Th;s application is made in compliance with County Ordinance No. 549. JOB ADDRESS D OCATION ------�'7 _ =" `" r Owner's Name --•------------------- ----- _ _ Phone-------------------- Address----------------------- -------- _-1-- Contractor's Name ---------••-----`o` w` ,- Phone 7 Installation will serve: Residence 0 Apartment House ❑ Commercial ❑ Trailer Court E] Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms __.2-_ Number of baths _/--- Lot size ---------- � ------------------- I Water Supply: Public system JA Community system 0 Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes No E] New Construction: Yes No L] `i .I TYPE OF INSTALLATION AND SPECIFICATIONS: ' (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well- -Distance from foun tion_._--� _-------.Material__--------------------------------------------- ------------------------------------------ No. of compartments-----____'�----------Size_--------_X_,1 - -- -___-- -_Liquid depth--------�-------------Capacity-------�vd----- Dispos I Field: Distance from nearesh well-____- ____--_Distance from foundation-__f i-____-Distance to nearest lot Number of lines------------'�----------------Length of each line-------------&al-------Width of trench--------------- -Lr'-------- Type of filter material_1_ry_$_1'.----__Depth of filter material-------- l9ri--__--Total length----__-----___- -ZQ-� -_.---__-,-_ v" Seepage Pit: Distance to nearest well ---------------Distance from foundation--------------------Distance to nearest lot line----------------- El --_- ____---__❑ 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 to nearest lot line------------------------ ----------------------- -------------------- ----------------------------------------------------+ r - ri Remodeling and/or repairing (describe)--------------------------------------------------------------------------------------------------------- ----------------------------------- -------------------------------------------------------------------------------------- ------------------------------------------- ---------------------------•--•------------•---•--•-•---------- ••------•---•--••-------------------------------------------------•-•---------------------------------------------•----...-...------------------------------ u -------------------------------------------------------------------------•---------------------------------------------------------------- ---------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County x'A` ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)--,,----: )Owner and/or Contractor) R By: ........ •-- ------- (Title (Plot plan, showings zeof lot, location of system ina elation to wells, b dings, etc., can be placed on reverse side). Pd.k DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------- - --------- - ------------------------------------------------DATE--- r- DATF -- - REVIEWED BY-- I ISSUED - ------ > --- .. - -=-- ----------------------- ---------------- BUILDING PERMIT ISSUED - ------------------------------------- ------------------------------------------------ DATE--------------------------------------- -=- Alterations and/or recommendatio s: -------------------- /,o s----z- ��,�,�'a --------- ----- - ----------- -----= _ --------- ------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------/------------ ------------------------------------------------------------ - --------------------------------------------------------------------------------------- ------------ --------- - -------------------------------------------------------------------------------------------------------- ----------- ------------------------------------------ --------------------- ----------- ----------------- ------------------------------------------------------------------------------------------------------------- .FINAL INSPECTION BY-- ------- ---------------------- ------ ---------- Date----/ Y- `_ I, SAN JOAQUIN 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 8-51 Revised W-2100