2464 - Laserfiche WebLink

Home Browse Search

' APPLICATION FOR SANITATION PERMIT �?&rIt No. 1j� _. (Complete in Duplicate) Date Issued _y ____'� 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 compliancef with County Ordinance N 49. JOB ADDRESS L CAT N 1 � L`--eJ' ``` --- ---------------------------------------------------------------- Owner's Name------------ -- -- - - ------ ---- -------------- - ------------------------------------------------------------------------------------ Phone_ � .vl---•---- Address--••-- Tc-------- --------- -- -------------- -------------------------------------------------------------------------------------------------•------------ ---•------------ Contractor's Name--- ------------------------- ------------------------------------------------------------------------------------------- --- -------- Phone------------------------------ 1 Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court' [_1 Motel ❑ Other Number of living units: ____/__ Number of bedrooms ---Z Number of baths ___I___ Lot sizes _-__ _�_ ______________________ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table fft. Character of soil to a depth of 3 feet: S;�PNew Gravel E] Sandy Loam Clay Loam Clay ❑ Adobe E] Hardpan I--]Previous Application Made: Yes E] No Construction: Yes [ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if-public serer is available within 200 feet.) Septic ank: Distance from nearest well l Dista//nce�rom foUn�)ion----1__0--------Mat rjal___�`_ -�_________ No. of compartments-----_-----Z.+------- ize_!_�'_xx____--Liquid d ph_______T---------------Capacity-----9 - - 1� Dispo Field: Distance from nearest well -_ _______ ._Distance from foundation-----��_ "��_Distance to nearest # np�__�____ � Number of lines__________ __ _ _________ ___Length of each line____ �=__I�___-Width of trench_____ _ _________________ w !� t of filter materi 'I• De X.-Depth of filter material______ �_ ______ p .Total length-------/-0_-0----------------- Type 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______-________________-____________-. ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-----------------____.___._________- ❑ Distance to nearest lot line------=------------------°==_-------------.------ -- T--_-:_ -------------------------- -----------•---•---------------- 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 Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)--r� ` ---------- --------------------------I-----------------------------------------------(Owner and/or Contractor By:------------------------------------------------------------------------------------------------------------------------------------(Title)---------------------------------------------------------------- (Plot 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-----/�T ----------------------------------------- REVIEWEDBY------------------------------ ..- ------------ ------ - ------- --- -- ------------------------- DATE---------------- BUILDINGPERMIT ISSUED------------------------------------------------------------•----------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations:------------------------------------------------------------------------------------------------------------------------------------------------------------- -•---•---• -------------------------------------------- -------------------• ------------------------•--- r ----------- --------- -------------- ------------------------------ ------------------ - IV ------------------------------------------- ------------------------------------------------------------------------------- --------------------------------------------------------------------------------•------------------------------- -------------------------------------------------------•--•--------------------------------------------.----- FINAL INSPECTION BY----------------- ------------------- Date-----?-- -y 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