2461 - Laserfiche WebLink

Home Browse Search

,' •� �3�� APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) ,s Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein rdescribed. This application is made in compliance with County /Ordinance No. 549. JOB ADDRESS AND LOCATION./ -��- <' ' ' ------------------------------------------------------------------------ Owner's Name-------- _ � _-A_/'.------ Address---------------- �''�� `� ---- Contractor's ----------------------------------------- Phone--- _ 1 -- '----- Installation will serve: Residence 1p_�partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other [❑ Number of living units: _/__ Number of bedrooms __ Number of baths J____ Lot size ---;i _-_:_ _sl'__ -_--____________________ Water Supply: Public system 2r-community system ❑ Private ❑ Depth to Water Table4-47__ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe W<ardpan ❑ Previous Application Made: Yes ❑ No A"<ew Construction: Yes No ❑ 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 foundation--------------------Material______-----__-__-______________________________- � - No. of compartments--------------------------Size-------•------- ----------------Liquid depth--------------------------Capacity--------------------•-- Disposal Field: Distance from nearest well_________________Distance from foundation--------------------Distance to nearest lot line_________________ ��(/� �• Number of lines-----------------------------------Length of each line------------------------------Width of trench----------------------------------- ,. Type of filter material-------------------------Depth of filter material----------------------- length________________________-________________ - ,f Seepage Pit: Distance to nearest well_ V,/5�____Distance from foundation__ -------------Distance to nearest lot li ________ [ � Number of pits---/----------------Lining material_ a ;f: __.Size. Diameter__c A_ ________Depth-___�r._____ --- Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining material-___-_-_____-_________________--_____. 171 Size: Diameter-------------------- -----Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy- Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ ❑ Distance to nearest lot line Remodeling and/or repairing [describe:____._____c� _ 1'ff1, _ f _ ------- , / ------------------------------------- -------------------------------------------------------------------------------- -----------------------------------------------------------------------------------•---------------------------------------------------------------------------•-------------------------------------------•---------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, /�S°°--t��ate laws, and rules and regulations of the San Joaquin Local Health District. (Signed)..... P� ------------------------------------------------------(Owner and/or Contractor) BYE � ---- --------- ------ - - ---------------------------------------------------ITitIe) � Q ------------------- (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--- ----------------------------------------------- Y-- DATE--- ----------------------------------------------- REVIEWEDBY------------------ --------- - ---------------------------------------------------- ---- ------------------ DATE BUILDING PERMIT ISSUED-------------------------------------------------------------------------- --------------------------- DATE Alterationsand/or recommendations:------------- �--------------------------------------- :--------------------•-------------------------------------------------------------------- ------- - 1$ - '' --------------------------- ---- ----- ------------- ----------------------------------- --------------------------------- -------------------------------------------------------------- --------------- -------------------------------- -------------------------------------------------------------------- ----------------------------------------------------- -------- - --- ------------------------------------------- •- - ----- -------------- -- -------------------------------------- ---------------------------------------- n � FINAL INSPECTION BY--------- ------ `�-- '------------------------- Date-------- 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 E5-9-2M 8-51 Revised W-2100