7581 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. ...... (Complete in Duplicate) ,'J � ` Date Issued - l_� r -��+ Applica-lion 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. 54 . , JOB ADDRESS AND OCATION........ -------------- ------- - --•------------------------------------------------•----------- Owner's Name------- - -------- Phone Address----------.....- f , ------------------------------------------------------•----- ----- --------------------------- Contractor's Name _y - �- -- ' Installation will serve: Residence.&""Apartment House ❑ Commercial ❑ Trailer Court ❑ r�Motel ❑ Other ❑ Number of living units: - __-_ Number of bedrooms Number of baths -_/--_ Lot size ------------•-------- 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 JEJ, Hardpan ❑ Previous Application Made: Yes ❑ No 9- New Construction: Yes R�_ 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_:V Distance from foundation--------------------Material fo. of compartments-- ----------------------Size--•---------------------•-------Liquid depth---------------- Capacity Disposal Field' istance from nearest well-----------------Distance from foundation---------------------Distance to nearest lot line--___--------_- • umber of lines-----------•-----------------------Length of each line------------_-----------------Width of trench Type of filter material---------------_---.___Depth of filter material-------------------___-Total length--------------------------- Seepage Pit: Distance to nearest well----f .Distan ��f•om"foundatio __ -____.Distance to nearest lot ® Number of pits----- ___----------Lin ing mater L, _ ce: D meter__-- `v--_Depth---" ________-•-- Cesspool: Distance from nearest well-------------___Dist rae fromhfoan`ddtion-:-.-_--.---.---__;.Lining material----__- .--__--.---_-----_-. 4y ❑ Size: Diameter-------- ---------------- - -------Depth- -- ----------------- ------ --------- - -..--Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance .from 'nearest building ❑ Distance to nearest tot line-----------------------------•-.--------------------- 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, StateI nd rules and regulations of the San Joaquin Local Health District. -(S�s �w•nerand/or Contractor) ) -----------------------------(Title)-By, (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------=L - REVIEWED BY-------------------------------------- --- ---- ----- ------------------- ------------------------- DATE------------ BUILDING PERMIT ISSUED.-----------------------------\....��-- ---- - -----•--------------.-------------------•-•--- DATE-------------- Alterations and/or recommendations:----------------�_-L- - �- ----------- _ ` �. -� f ---------- -----------------------.----- ----- --------- - -------- ----- ---------------------- - ----------- ------------------------- --------------------- ----------------- ------------ FINAL INSPECTION BY:------C- S---------------------------------- C ��]� Date --------- ----'---v--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 145446 ATWo 12-54