7215 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) , Date Issued -- r Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. Thisapplication is made in compliance with County Or nance No. 549. mr- - 2 JOB ADDRE S AND OC I - - -- -- --- --- Owner's Name ---------- ---------- Phone------------ ` Address------.------`9 Contractor's Name -- ---- -- ------ Phone <,_So_. . Installation will serve: Residence ❑ Apartment House [] Commercialrailer Court ❑ Motel ❑ Other Number of living units: -------- Number of bedrooms _._-___ Number of baths -� x b ❑ ----- Lot size --- --�---- - ----�-�---- Water Supply: Public system [�---EaTRmunity system ❑ Private ❑ Depth to Water Table _b.d_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam 21-Glay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes 4-140-El •# TYPE OF INSTALLATION AND SPECIFICATIONS: 14 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-124 i3 �_Distance from foundation----/0........Matejial-__ __ _.__ ---- -- ~ -- Size__ ' p No. of compartments -- 10---X-u4•-------Liquid depth-----------------.Capacity-'�`� ------- Disposal Field: Distance from nearest we4#VV*c-`--Distance from foundation_-f8f_-_._.__.Distance to nearest lot line__L `__f______ Number of lines-------1__----- - --- Length of each line-2S--�_----------------.Width of trench---,_7E- _`--------------- /� v Type of filter material___ ____________De th of filter material__- Q___.____----Total length y� Seepage Pit: Distance to nearest well- ---Distance from fo ndation__. .r r T' ,p�� __Distance to nearest lot line___sT' -rq, � 14— Number of pits---/----------- ---Lining material__, .r' __.Size: Diameter_ -'- Depth-.?-P--'---------------------- Cesspool: Distance from nearest well-________________Distance from foundation----- --------Lining l material_ ____ ___.____.❑ Size: Diameter------ _.____________ Depth -- ----------------Liquid Capacity- --------------------------ga._s i Privy: Distance from nearest well..................... -------------Distance from nearest building 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, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed). - r ---- • --- -- ----- ----------- ------- --- ---- -�---------------•--------- ------------ ------------- �--------(901119 -vndfer-Contractor) 8y:. --------------- ---------------------------------- -•- ------(Title)--------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). EPARTMENT USE ONLY APPLICATION ACCEPTED BY______________ _------__ K -------- -�---- D ------------ -------- - EVIEWED BY ----- ------ ----------- ---------------------------- DATE--- UILDING PERMIT ISSUED-------•------------- --- --------------- -----------------•- ------ DATE.----- ---- ------------ Alterations and/or recommendations:. ------------- --- -------- --- ----------------------- ------- ------ --- -------------------------------•---•-------------- •---- ---------------------- ----- -------------- ----- FINAL INSPECTION BY: _:. ----- ---------------------------- Date SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wast Oak Street 132 Sycamore Street 014 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-5-2M 145446 ATWUCD 12_5a