SU0004637 - Laserfiche WebLink

Home Browse Search

------------------------------------------ ---------- -----------'--------------------------------------------- A ,.ICATION FOR SANITATION PEVA Permit No. ..r ------------------------- ------------------------------- (Complete in Duplicate) �. Date Issued This Permit Ex ices 1 Year From Date Issued l Application is hereby made to the San Joaquin Local Health District for a permit to consruct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION_`S........---- ----------- qOwneris Name.-- -- -------------------- --- ---- ---- ------ ------------ Phone------------------------------------ Address__.-•----•--- Contractors Name --- --- ---- - -----=---------------------------------------••---- Phone-----------____.....' Installation will serve: Residence ❑ Apartment House ❑ Commercial [] Trailer Court ❑ Motel ❑ Other ' 4 Number of living units: _,'"_ Number of bedroomss"r---- Number baths __/... Lot size --- -- - --------------------------- Water .Supply: Public system E] Community system Ll Private Depth to Water Table _ ____ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam El Clay Loam [ Gay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: {lf yes,date------------.._----) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ' from � 1 Septic k: Distance from nearest well__________Distance foundation___1_P_______._.IAater L_� +�� - __._____. ; No. of compartments------�---------____Sizea._�_I.___eK_$_.___Liquid depth_-.---- _--_._____.____Capacity___�Q0�� Dispos ield: Distance from nearest well----Sn_____.Distance from foundation----/_Q---.-.._...Distance to nearest lot line-_______,�'___ CV Number of lines__________/_________.._____.____Length of each line--------o-__'_________.Width of trench_____ -__-______________________ a� Type of filter material...-..�__0 _:.____Depth of filter ma#enaL______E_�f--___--_-�'otal length___.��t__!_________________________ �, , s / Seepa PIt: Distance to nearest well_--.�_-__ ._______Distance from oundation____/.Q__:___.__.D,stance to nearest lot line_________ ______ Number of pits--------l___._____Lining material_____-(_j .....Size: Diameter-_,? ...........Dept h__-ZX_--___________________ Cesspool: Distance from nearest well------------------Distance from foundation--------------------Lining material_____.________.______________-______ ❑ Size: Diameter--------------------------------------Depth. ----- •------------------------------------------Liquid Capacity------------------ ------..gals. C Privy: Distance from nearest well__________________ _________---______._____--_.-Distance from nearest building__________-__-_-.__-_----___-_._-.-_----_. ❑ ,. Distance to nearest lot line.---- ------------------------------------------•--------------------- - - . Remodeling and/or repairing (describe)------------------- ---------------------------------------------------•------------------•----------------------------•---------------- ------------------ V 1------- -------------------------------------------------------•--------- •----------....-------------------------------------•-•-----------------•----------------------------------------------------------------------------------- ----------•------------------------- ---------------------------------------------------------------------- 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 and/or Contractor} B :. - Title y ------------ ----- ------- { )---------------------------- ------ (Plot plan, showing size of lot, location of system in relation t wells, buildings, etc., can be placed on reverse side). t FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- DATE_._ -� --- -- -- --- -------- - REVIEWEDBY------------------------ -------- ----------------------------------------------------------------------------------------•- DATE------•----_------ I BUILDING PERMIT ISSUED------ --------• ---------------------------•-------------------------------------------------------- DATE-----------------•----------------------------------------- Alterations and/or recommendations:--------------------------------------------------------------------------------------------------••--------••-------------•------•----------- --------- ----------------------- ----------------------- ----- ---------------------------•--••------------------------------- -----------------------------------------------------------------•--------.------------------------- -------------------------- ----- ----------------------------------------- - --------------------------------------------------------------•-------------------------------- ---------------------------------------------- --------------------- FENA`L INSPECTION $Y: �"* Date ._". --------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hoxellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.ra.