3638 - Laserfiche WebLink

Home Browse Search

l 7ice y APPLICATION FOR SANITATION PERMIT Permit No. -------------- ter' �„t (Complete in Duplicate) Date lssf ?/o n ------ "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 w'-- County Or inance�No. 549. JOB ADDRESS A LO ATION__ t ___ +" �---/?--� '---`---- ---);p- 1 ° `� f C ^~T� Phone ------------------------- Owner's Name--- -- -- -- ---------------�•- - - - - --- -- -- --------- ------------------` Address---------- `��-----= t/ - Contractor's Name---------1---- ------------------------------------------------------------------------------------------------------------------------------ Phone----------------------------------- Instailation will serve: Residence Q,-Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living un-its: _--/--- Number of bedrooms ---/--- Number of baths -1---_ Lot size ------------ -- -- -------- ------------`-- Water Supply: Public system ❑ Community system ❑ Private Ek—,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 New Construction: Yes Rr'-N-o ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: i (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Material-----_----------------------- Septic ank: Distance from nearest wall---_ _+ .Distance from r`o{{undation____ _f -- �+ No. of compartments------- -----r----------Size_ _ tet_:- ---Liquid depth-------- ---------------Capacity----- -'- Dispos Field: Distance from nearest well-)-_L-d---Distance from foundation-_-,�1-0_-----_Distance to nearest lot line-_-----_- 1 Number of lines--------/----------------- ---- -----Length of each line---,_____�Crd_____---------Width of trench- ------ ht_ _-----.------__ Type of filter material-_-_- Depth of filter material-----l_-�N-------Total length---- Q----------------------------- Seepage ------- --------------------Seepage Pit. Distance to nearest wDistance from foundation------__.----__-__-.Distance to nearest lot line------------ F1" _-_--____--❑' Number of pits____-___-------------Lining material-----------------------Size: Diameter-----------------------Depth_---__-_-___-___-----------_-_- I Cesspool: Distance from nearest well----------------- from foundation-- -------- - ------------------------------------- Size: Ze: Damter - Depth -- ----LiqquidlCapacity----- ----------_.----_gals. t ❑ _ -Distance"'from-nearest well =::-- --- ---- ----- - -------Distance fromnearest building---------------------------- -. ❑ Distance to nearest lotline------------------------------------------------------------------------------ ---------------------------- -------- -- ---- Remodelingand/or repairing (describe)-------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------- ----------------------------------------------.11---------------------------------------------------------------------------------------------------------------------------------------------- --------------------------- -----------------------------------• --------------------------------------------------------------------------------------------------------------------•-------------------------------------- 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 regulatio —qf A San Joaquin Local Health District. Signed) -_-- Nil G(Owne)rnd/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 BUILDINGPERMIT ISSUED----------------------------------------------------------- ---------------------------------------- DATE--------- ------ ------------------------------------------- Alterations and/or recommendations:- °----- ----------------- -- �------ ---------------d`� �-------------- �'-"'`c � -/e�'-- L. �. I --------------------------------------------------__-_--- ---.----------------------------- ---- ------------------- ---------------------------------------------------- _._-_-.---- _--�?- --------------------------------- -----_-_-_-------_-_.---------------------------- --__-_------ ---_ .--.-------_-----_--------_----.--------------------.�! t-_---- -------------------------- ) I," - --��4-a� 5-------... - FINAL INSPECTION BY:-- _,-7----------- _----- Date---------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street p Stockton, California Lodi, California Manteca, California Tracy, California E5-9-2M 8.51 Revised W-2100