9998 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. _ _ _ ___ (Complete in Duplicate) '7/y��,s Date issued ___ _________/______ 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 compliance with Count Ordinance No. 549. y JOB ADDRESSLOCATI .�- -- ------- ---- Owner's Name Phone ----------------- Address---------------- ---------------------- --- ---- Contractor's Name--------------- - ----- -- - --- --- ------------------------------------------------------------------------------ Phone----------------------------------- Installation will serve: Residence "Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ cq ` / Number of living units: _-1--- Number of bedrooms -_pc..Number of baths ___�� Lot size _� Q_ -�G __ ------.----------------- Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table _ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ ` Clay Loam [❑ Clay ❑ Adobe fardpan ❑ Previous Application Made: Yes ❑ No Z?00'*New Construction: Yes ❑ No FHA/VA: Yes ❑ No R�-- J TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.), ltic ank: Distance,from nearest well_________________Distance from foundation_-_-.--_-___--------Material--_---_---______--..----_-...______--_-_..______- -----------Li uid deNo. o€ compartments--------------------------Size--------------------- q i?th---------------- --------Ca pacity---- --------------------4 p al field: Distance"from nearest well___ Distance from foundation1 -------Distance to nearest lot line__..---- : Number of lines___________________________ __Length of each line______JA� -----------Width of trench______�__________.____ Type of filter material/__ _ __ _.-.__Depth of filter material---fr�_-_______Total length-------1f0__/--------------------- Seepage ____________________ p g to nearest well-____ f?`Distance om undation___ _�___.Distance to nearest lot line__.®-/ See a e t: Number of pits------/------------Lining material_ _________Size: Diameter-__ . � -�--------.Dept h------121.d�----------------- Cesspool: Distance"from nearest well-----------------Distance from foundation--------------------Lining material________._.___________-.____________ f Size: Diameter---- ---------------------------------De th----:-----------------------------------------------Liquid Capacity --gals. Privy: Distance jrom nearest well-------------------------------------------------Distance from nearesf building----------------------------------------_ ❑ Distance.to nearest. lot line------ ------------------------ ------------- ------------------------------------------------------------------------- 4Remodeling and/or repairing (describe)------------------ l---------------------------- ------------------------------------------------------- ---------------•---------°- -------------------------------------------------,----------------------------------------------------------------------------------------•----------------------------------------------------------------------------------- ------------------------- ----------=------ ------------------------------ ........-------------------------------------------------------------------------------------------------------------------------- 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 regulation of the San Joaquin Local Health District. (Signed)---------- ----------te� Contractor) Aqf BY:------------------------------------ ---------- -------------------------------- --------------(Title)----------- -- --- V ----------------------- (Plot plan, showing size of lot, I ion of system in.relation to wells, buildings, etc., can be placed on reverse side). f FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------------------------- --- -- ---------------------------------------------------- DATE---------- --- REVIEWEDBY--------------------------------------------------------- --- ----- --- DATE---•----- BUILDING PERMIT ISSUED----------------------------------- --- -------------------------------------------------- ------ DATE------------------- ----------- ------------------------- Alterations and/or recommendations------------------ ----------------------------------------------------------------------------------------------------------------------------•------------ ----------I------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------- -4P ------ INSPECTION BY:-'-- -- ------ ------ Date------ `_ w SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street y 132 Sycamore Street 814 North "C" Street , Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 1.57 F.P.Co.