2450 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. -----.2 (Complete in Duplicate) Date Issued _f�_ 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 LOCATIONS- ---------- -------------------------------------------------------- Owners Name---(-._ ( �� - ---------------- ------------------------------- --------------------------------------------- Phone------------------------------------ Address---.-----------/--7 e_J- --- `" w=�L-----------•------- ----- ----- -- - Contractor's Name---------------- --- ------- Phone ---------- Installation will serve: Residence K Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___/--- Number of bedrooms __a" Number of baths ---I--- Lot sizex___k_ -7--____________--------------- Water Supply: Public system,K Community system -❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobejK Hardpan E3% Previous Application Made: Yes ❑ No_f� New Construction: Yes M No ❑ a� 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______-0--------Material----- ----__�_7_ ____- 9 No, of compartments----------7a—'--- ----Size__#A_*'A--- ----------Liquid depth________3'_'.__________Capacity___J94W_ __r_/ Disposal Field: Distance from nearest well-----_--�----Distance from fount}afion------►_f��_______.Distance to nearest [of � lNumber of lines------ of each hneA) A?,__*��__-.Width of trench______ __ '"____._- Type of filter material---------------_---------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________----_______._________-.___--_ ❑ 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):_-------------- 1Caj---------------------•------------------------------------------------------------------------------------•------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ s ------------------------------------------ ------------------ ------------------------------------- --------------•------------------------------------------------------------------------------------------------ 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)�!-'�-=-— ----------------------------------------------------------- ----------------------------------(Owner and/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--- lig BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE Alterations and/or recommendations---------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------I------------------------------------------------------------------------------------------------------------------------------•------------------------------•-----------------------------1. 1 ----------------------- ------•---------I--------------------------------------------------------------------------------------------------------------------------------------------------------I------------------------ ----------•----------------------•----=----------------------------------------------------------------- ----------------------------------------------------------------------•---------------------------------------------- -- - ---------------- - --------------------------- --------- ---- -------------------------------------------------------------- _ Q FINAL INSPECTION BY:_ `� -----------�"--"2_S5 `--- --- ----------------- ------------- --------- -----'---- - - - 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 ES-9-2M 8-51 Revised W-2100 ��