2539 - Laserfiche WebLink

Home Browse Search

73 K APPLICATION FOR ,SANITATION PERMIT Permit No� (Complete in Duplicate) Date Issue •:"_�S__ k Application is hereby made to the San Joaquin Local Health District for a permit to construct and install +he work herein described. This application is made in compliance with County Ordinance No. 542. JOB ADDRESS AND LOCATION- ------------------------------ Phone Owner's Name___-_________. Address---------------- --- _________ --- ____________________________ _ Contractor's Name--__- t° d{-- _-- --Q cE� sem/-�r .� ) ------------ Phone---_��1 'fit Installation will serve: )Residence �artment House ❑ Commercial,❑ Trailer Court ❑ Motel ❑ Other ❑ Number of'livin units: __ m _ - gNumber of bedrooms -- Number of baths ___ Lot size _-__��_d1Yl_.2_o______-----___---__ Water Supply: Publiclsystem ❑ Community system.-E] Private d?-_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 ❑ No Nei 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_____________)___=r:Ma+eriaE______________.____________-___________.________-�r X� No. of compartments----------- ---1---------Size--------------------------------Liquid depth--------------------------Capacity Disposal Field: Distance from nearest:.well__�-__-_--,Distance from foundation___ _ ___--Distance to nearest lot line---� Number of lines_ _ �__ti__4'<-- V—, Lengthof each,line--__-•-- --- � -----Width of trench-_ -�-- ----Type of filter material __--_De th of fii+er material- __._ ____iotal leng+h_--.______ _d------------- -- p - /- Seepage Pit: Distance +o nearest- llwe ______________________Distance from foundation__-_.________ _-___.Distance to nearest lot line-------- ] ❑ Number of pits-------------------•---Lining material-----------------------Sizer Diameter-----------------------Depth------------------------- -------- . Cesspool: Distance from nearest well_________________Distance from foundation------------- _---- Lining material--_______--_______ ____- ❑ Size: Diameter--------------------------- -- -------Depth-------------=-------------- 4 = Liquid Capacity gals. Privy: Distance from nearest weli___________________________-----_-------------Distance from i. nearest building__-_______-_________ k ❑ Distance to nearest lot line------------- ---- r` --- ----------------------------------------------------------------_-------•--------------------- Remodeling and/or repairing (describe)_____________ _ w /� r ---- ------- ----- ------------------------------------------------------•----------------------------------- l =--------------------------------------`--- ( , ,w l 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. 1! (Signed) - y - --------------"------------------------ {O ner a /or Contractor] BY: � = ----- --------------------------------------------- -- ------(Title)-- - --- - ---- - -- ----- -------------- (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_ ---------------------------------- REVIEWED BY----------------------•------------- - DATE------"kx- ; BUILDING PERMIT ISSUED----------------- -------------- � ----- - ---------------------- ------------------- ---------------- DATE--------------'�- ----------------------------------------- Alterations and/or recommendations_________________________ ------------------------------------------------------------------------------- ------------------------------------------------------- ------------------------------------------------------ ----------------------------------------------------------------------------- ----------------------------------•--------------------•------------------- -------------- r ---------- FINAL INSPECTION - --------------- Date---- - ------------------------------------------- ----------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 1 300 West Oak Streat 132 Sycamore Street $14 North "C" Street Stockton, California' Lodi, California Manteca, California Tracy, California ES---9-2M B-51 Revised W-2100