8790 - Laserfiche WebLink

Home Browse Search

jAPPLICATION FOR SANITATION PERMIT Permit No. .___Q--_!-��Q__ (Complete in Duplicate) r! Date Issued 4Applica4ioin 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 LOCATION------------- Q_`r's- ----------- - ---- Owner's Name Phone �`ya�_7 ------------------------------------------ ----- ------------------- - Address �'�� Contractors Name_ ------ Phone,l �._[ _`"_ _0 7 [�� _ - - - -- - ----------------- a.t'YCC Installation will serve: Residence ®�partment Hausa ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___. _ Number of bedrooms 3_. Number of baths __ Lot size _ -------- -------------------------- Water Supply: Public system d—tommunity system ❑ Private ❑ Depth to Water Table _v ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [Hardpan Q Previous Application Made: Yes ❑ No Ej�_New Construction: Yes ❑ No [� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ptic Tank: Distance from nearest well_________________Distance from foundation----------------- _.Material---_______.______-____.._ -------•-------------- No. of compartments Size------•----------------•--------Liquid depth--------------------------Capacity----------------------- Psp?osfal ,i�Ud: Distance from nearest weft------------------Distance from foundation___________________Distance to nearest lot line----------------- ^t Number of lines-----------------------------------Length of each line------------------- -_-.Width of trench Type,of filter material-------------------------Depth of filter material--.-----.---------------Total length--.--------------------------------------- Seepage Pit: Distance to nearest eIIG!/ istance om f undation----------------- Distance to nearest lot line-_ ��___ Number of pits.------ -_.__________Lining material-_-__ __- .___. _ Size: Diameter___.__- -- c� - 3,�--------.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-------------_------------- Q ❑ Distance to nearest lot 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, Stage laws, and ales and regulations of the San Joaquin Local Health District. 4 (Signed)------ ------------•-•------- ------4- ------- ------------- ----- - -- -(Owner and/or Contractor) t BY: ([,� --------------------------- ---- - --------------------------------------------(Title)------ -j-------------------------- ---------------- (Plot plan, showing size of lot, location of system in lation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----------- ---- - - --------------------------- •----------- DATE.----- .---------- ---- --------- ----------------------- REVIEWED BY------------------------------------ ----- -------------- ------- - -------- ------- -------------------------------- DATE BUILDING PERMIT ISSUED------------------------ --------------- ----------- -- DATE Alterations and/or recommendations:________________ _____ ----------------------------- ------------------- ` - - .: .a . :_ --------------:--•-------------------- ----------------------------------------- - -- ----------- --------------- - ----------------- ------------ ------------------------------- ----------------------- --------------------•----------------- FINAL INSPECTION BY:.... „_ Date -- © S� ---- --- • -- -- ----•------------ --------------------------------•- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street $14 North "C" Street Stockton, California Lodi, California Manteca, California Traty, California E5-9 145446 AT waoo