793 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein de This application is made in compliance with County Ordinance No, 549. scribed. JOB ADDRESS AND LOCTION___= ___ _____ (�_- r -_----------- ------------------------------- Owner's Name - - - -------------------------------------------- Phone Address -------- Contractor's Name_______________ _ . ----------------------- - -•---------------------- --------- -------- ----- _ Phone----------------------._ --------------------------- --- _ --------- - nstallation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motels❑ Other ❑ Number of living units: Number of bedrooms • a ��umber of baths [�] Lot size-----__f�__,!J- ------------- 'Water Supply: Public system ❑ Community system-❑ Private' Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam 0 Clay Loam ❑ Clay p Adobe.�L+ 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__'_0_�.Distance from fou 7t70 _tion____ :-.- No. of compartments__ ________rl ____CapacitY___ -Size__ t�(�-�}erial_Liquid depth_---- __ - Cesspool: -Distance from nearest well-----------------Distance from foundation----________--------Lining maferial_-____________.----- ---------------- ❑ Size: Diameter-----5--------------------------------Depth------------------- - ------------ - ---------------- 'Privy: Distance from nearest well-------------------------------------------------Distance from nearest b0clin g -------- ❑ Distance to nearest lot line_________ - - ------------ Seepage Pit: Distance to nearest well __________Distance from foundation-------------------- ❑ Number of Pits_____________________ Distance to nearest lot line-___-__-_________ Lining material---------------- ------Size: Diameter-------•------------_--.Depth--------- ___--• ------------- Disposal Field: Distance from nearest well----,-(.Distance from foundation____,/__Q-______Distance to nearest lot line_ _ VNumber of lines______________ __ Len Length of each line__-____ g L_ ------Width of trench---------- Type of filter material____ _V-____ -,Depth of filter material-------- "Remodeling 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 I and r les and regal tions of t. San Joaquin Local Health District. [Signed)------------ - . --------------- ------- - -----------------------(Owner and/or Contractor) BY:---------------------------------------•--------------------------- Title (?lot plans, showing size of lot, location of system in relation to wells, buildings, etc., must be filed with this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------------- -----. DATE_--------__ ]- - - , w --------- ----- REVIEWED BY ------------------------------------------------------------- D TE DATE- ---------- ----------- ------------------------------------------- --- BUILDING PERMIT ISSUED ------------------------------------------ = ----------- ----------- - --------------------------------------- DATE-------------------------- A terations and/or recommendations------------------------------ --------------------•- -------------------------------- =--•-------- ------------- - J PERMIT No.. ---/ ----- ISSUED--- ' 7 .5`�.___(Date) FINAL INSPECTION BY:_ ----- e(�-__. Date - ` --------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street ES-9-2M 9-50 W-1639 Stockton, California