6067 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued _-- Applica�ion 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 LOCATIO --.-------7,�lw---- ------ ---- _ _-- - F __________ ______________________________________________ Owner's Name ..------- f '-110, -.---.- - Phone Address----------------------- ;V,- Er,, -- •----- -- ------ --------•-- ------- Contractor's Name_____________ - --s --- --------e---a- --,5---- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court Motel Other Number of living units: .___ umber of bedrooms __/__ Number of baths l----- Lot size --------/--S^Q-_X_---_- Water Supply: Public system Community system ❑ Private Ej Depth to Water Table L __ ft. f Character of soil to a depth of 3 feet: Sand ❑ ravel C-] SandyLoam E] .Clay Loam E❑ Clay E] Adobe Hardpan 0 Previous Application Made: Yes E] No New Construction: Yes No ❑ k ` TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic an : Distance from nearest well_________________Distance from foundation--------------------Material No. of compartments--------------------------Size._-----------•------------ ---Liquid dept------------ ------------Capacity----•----------------- / J/ Disposal Field: Distance from Weare wel��// istance from foundation___ -- __._.Distance to nearest lot line__---?`- .- [�''� Number of lines-_ - ---- ___Length of each line___.-, __:___. _ Width of trench-. r Type of filter materi _ fl.--Depth of filter material__.,--- -/-_-_.Total length__________ ----- ----------•--_--- Seepage Pit: Distance to nearer well�W Distance from foundation__,- ��____ Distance to nearest Io} line____�d._-._ ❑ Number of pits._.•-------Lining material_ et_ -Size: Diameter_---- -�-�f ' 7'- -- Depth -------------- Cesspool: Distance from nearest well-----------------Distance from foundation-------------------- Lining material_________-_-.-----________________ ❑ Size: Diameter--------------------------------------Depth------------------------------------ --------------.Liquid Capacity----•-----------------------gals. Privy: Distance from nearest weEl---------------------------------------------------Distance from nearest building-----------------------------__----_- -- ❑ Distance to nearest lot line--------------------- -------r________------ _- � " 4 - ----------/-- ---- - � Remodeling and/or repairing (describe)=•-- - " �~' -t.-_.. ----------- f ----•--------------- -----•-----•------------------------------------------ -- --- .' ----------------------- --------- ------•---------------------------------------------------------------------------------------- = ._...1-107 ------ • I hereby certify the+ I have prepared this application and that the work will be done in aic`ordance with San Joaquin County ordinances, State la s, and rules and regulations of the San Joaquin Local Health District. (Signed)_____________ ___ �--_------- --�_ � (Owner and/or Contractor) y� . f ------- - (Title)•-----.. ------------- (Piot 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 J DATE------ ._...._u.7 f --"r REVIEWED BY -------------------- BUILDING PERMIT ISSUED ----------------------------------------------------------- DATE-------------------------- Alterations and/or recommendations:-------- •--------------------------------- ----•------- --------------------------------•----------------------- -------------------------------•------------------------------- --------------------------------------------------------------- �} -------- FINAL INSPECTION BY:-------------------L ----- - - / -------• Date----------- --3 7 J rJ ---- 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 E5---9-2M : Revised W-21 ao