2670 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. ,_E_7.-O____ (Complete in Duplicate) � 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 County Ordinance No. 549. JOB ADDRESS AND LOCATI. N.._» -'_-- - -- - --1_ r ---------------------------------------- Owner's Nam _e__ _ __!�___ _ - ---... -------.--- -- _ hone Address--------------c /_� Contractor's Name------------------- ----.-_-- - - -- - - - -k� wG �. - - --------- ----------------- - ----------=------------------------------ Phone__..---•" -- -_ -• �r Installation will serve: Residence Apartment House [❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: __/____ Number of bedrooms __Z__ Number of baths __l___ Lot size __-7 Water Supply: Public system ❑ Community system ❑ Private 2-'-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 ❑ Noe Construction:. Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: {No septicstank or cesspool permitted if public sewer is available with]MZ00 feet. Septic TanV- istance from nearest well_________________Distance - -----------------Material------------------------------------------------- o. of compartments ---Size-------------- ----------Liquid depth--------------------------Capacity---------------------- • � � Disposal Distance from nearest well_____a`�_ ___.._.Distance from foundation_____ _________Distance to nearest lot line.___6-_____ Number of lines-----------3------------------._Length of each line------------------------------Width of trench------ --I- �----------------- Type of filter material___-` —ajt._.___Depth of filter material------ _8______.__Total length----------�,----_ -- VA-Qu- Seepage Pit: Distance to nearest well__________________ __ �1.4 d 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______--________________ A,4, Size:-Diameter-_-- -------------------------Depth---------------------------=-----------------------Liquid Capacity---------------------- g - _ . -- Privy: Distance from nearest well -________.________________________________Distance from nearest buildin g ------------------------------ ❑ Distance to nearest lot line----,----------- ------------------------------------------ Remodeling and/or repairing (describe): 1-2- ____ _ - ____ _ ;��I -----------•-----------------=--r------------------------------ ---------•------------------------------------ - - ------------------- - ---------------- --------------- - ---------------------------------------------------------------- -------------------------------.---------------------- i ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------:---------- 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. { 9 ) --- ----------- ----- �- - -- ----- ----- - _ �_Owner and/ororContractor) B %__ ---------- ------------- ------------------------------------------------------------(Title)-----------------------•--------------------------------------- - (Plot plan, showing size of lot, locatiori of system in relation to wells, buildings, etc., carkbe placed on reverse side). FOR DEPARTMENT USE ONL APPLICATION ACCEPTED BY------ i --- ----------------------------- -- ---------- DATE----- •- -OF--------------------------------------- ------------ - -------------------------- REVIEWED BY ------------------ -------------- ---------- ------------------------------- DATE--BUILDINGPERMIT ISSUED------------ -- "`-``�- Alterati nsAnd/or Seco endations•- � u ---------- ---- ------------------------------- •----.----- .---_-:____ _.:-__�__-___- ------------- FINAL INSPECTION BY-------- --------------------�69��g .11 ------- ---•-- Date---------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Streat 132 Syeamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 8-51 Revised W-2.100,