3924 - Laserfiche WebLink

Home Browse Search

v;" APPLICATION FOR SANITATION PERMIT Permit No. .... ....... (Complete in Duplicate) 1 / Date Issued 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 with County Ordinance No. 549. t JOB ADDRESS AND LOCATI ---------Z---i 1-Yl Jit_ ---- -------------- --------------------- " Owner's Name-------- ------- -------------- Phone----------------------------------- Addressa------------------------- - Contractor's Name..... -----------------------------------------------------------------------------------------------•-- __ Phone-_..----------------------------- Installation will serve: `residence Z Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ ~ _ Number of living units: __.L___ Number of bedrooms __2__-Number of baths ___l___ Lot size _laz) ,---- -------------------- Water Supply: Public system ❑ Community system ❑ Private W- 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 9 No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: C _ (No-septic tank or-cesspool permitted -if public sewer is available within_.200_feef.) 10 Septic Tank: Distance from nearest well__-561.__Distance from foundation--/_ -.Material...A!'``��'� _7 •• T No. of compartments--------------- -------Size X.� _:- --- ---Liquid depth--------�_'-------------Capacity_2� - -_- Disposal Field: Distance from nearest well____�s?----Distance from foundation......:7c� --------Distance to nearest lot line---____� .� Number of lines------------- - Length of each line---- - - ---Width of french----------)--q"_______-_-- Type of filter maFerial______-�_�<. �-Depth of filter material_____-_IJ--`.____._Total length______________L_1_3___________-__. Seepage Pit: Distance to nearest well----------------_-----Distance from foundation--------------------Distance to nearest lot line-------.______.__ ❑ Number of pits--- Lining material-----------------------Size: Diameter-----------------------Depth---------------------------- Cesspool: ----------- ---------- 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---.----------------------------- El Distance to nearest lot line------- - Remodeling ant!/or repairing (describe)_______________________________________________________ -- -----------------------•----------------------------------------------•------------------------------- ------------------------------------------------------------ ----------- •-------------------------------------------------•-------•--------------------------------------------------------- ---------------•-------------------------------------------------- --------- I hereby certify_-that I ve prepared this applica on and that the work will be done in accordance with San Joaquin County ordinances, gte I s. an rules and re 1-ns f e S oaquin Local Health District. (Signed)� P'I - -— - �`.Y+_--_ )Owner and/or Contractor) By:------------------------------- - _ .._ "" '_. - '- :-- (Plot plan, showing size of lot, location of system in relation to wells, buildings, a+c., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------------------------------------- ----------- -- ------------------------------- DATE--------- - �- REVIEWEDBY - ------------------------------------------------------------------- DATE - -- -------------------------------- l1ILDING PERMIT ISSUED------------ --------------------------•-------------------------------------------------------------- DATE-------------------------- Alterations and/or recommendations--------- ----------- -------- _ -----•----------------------------------------------------- ------- ---- --- ------------------------------------------------------------------- ------------------------• ------------------- ------- - !- f �{ --------- -------------- FINAL INSPECTION- BY:. ----•- ------------- --- -- ---------- Date------------------ 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 ES-9-2M 10-52 Revised W-2100 j�