2880 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. __ _ ... (Complete in Duplicated ____ � A Date Issued _ �S'r_+��„ 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 Ordi ance,No. 549. �46 Li�3 JOB ADDRESS AND LOCATION___ _: __�-.Q :!_ _.__ :%��-�..��..1__e�.�-4�-�-►�°�' �� -rte---_____��-�/ Owner's Name--------- ----------------------------- --------------------------------------------- Phone .fit.Z_f�_, � Address-------- .......... � ��c C� ..a ------------------ --------------------------------------------------------------- Contractor's Name------------ -------------------------------— -------------------------------- •----- Phone------------------------•------ R Installation will serve: Residence'`:Apartment House�❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number- of living units: __/_ Number of bedrooms..'L Number of baths __L-_- Lot size ______.______-____-__ Water Supply: Public system ❑ Community system ❑ Private 54 Depth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand JK Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No L)� New Construction: Yes n No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer Iis available within 200 feet,) I Septic Tank: Distance from nearest well- fts l i-___.Mater-al___/ � r! ________________ static from foundation_-____ ___ No, of com artments_-------_ Size________ _ ____Li Liquid depth p p ,.. t / 1i� q Capacity €?-�-0---- Disposal Field: Distance from nearest well_CV-e_,V_s7_bDistance from found ation___3_0---------Distance to nearest lot Jine____-___ NPI' Number of lines-------------I__-_______ Length of each line-----/ozC,�_ _ _7!____-Width of trench-` _!_____ -________________ Type of filter material----s5 ____- Depth of filter material---- --------.-Total length______ _________________ 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------------------------------------- El Size: Diameter--------------------------------------Depfh----- j; Liquid Capacity--------------------------- gals. PrivDistance from nearest well -. P i__�________Distance from nearest building Y ---- V. g ❑ Distance to nearest lot line----------- ---------------------------------------------------------------------------------------------------------------- r�- 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) 4 ___Owner and/or Contractor --------------------------------------------------- ------------------------ Title ----------------------------- 1 (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). - 1 OR DEPARTMENTT-UStbNLY APPLICATION ACCEPTED BY I - ` ------ ------------------------------- DATE xrr REVIEWEDBY---------------------------------------- -------------------------------------------------------------------- DATE---S-e ----------------------------------------------- BUILDING PERMIT ISSUED------------------------ ----- -------- •-------------------------------------------------------- DATE--.-------.----.--_------------------•---------------------- _ Alterations.and/or-recommendations: _ __ __ _ _ _ -_ --------•---------- ' _ r,' - ----- ------------------------------------J---- --- - - ------------------------- -----•-----------------------------------------t-------------------------------------------------------v-------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ -------------------------------•---------------------------------- ------- -- ---------------------------- ------------------- --- ---------------------- FINAL INSPECTION BY:------------ ____-_______ Date-- -- ___-- r 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 B-51 Revised W-2100