4684 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. _=f � (Complete in Duplicate) - s�`f'� �� • (Com P P ) bate 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. JOB ADDRESS AND LOCATION--------- _--___� _--_--__ ,ye Owner's Name.... - n. _. :. Phone---�-�-3--`3- -- ------------•------------------- ----- - ---- - - ------------------- ----- -------- Address........:1 1---6---•---- = Contractor's Name -L ------••--•--------- ----------------------------------•-- -------•--•------------------- ------------- Phone----------------------------------- Installation will serve: Residence 03/partment House ❑ Commercial ❑ Trailer Court ❑ Motel 0 Other ❑ Number of living units: __�___ umber of bedrooms . -___ Number of baths __�___ Lot size ----73�k___"'1 Water Supply: Public system [Community system ❑ Private ❑ 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' No ❑ - TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-.1_U`.--------Distance from foundation__.1.0_ ___._..Mater ial_. jJ__."--_ - No. of compartments----�.---------------Size-- - 45-----------Liquid depth---- -� � pa -----Cacity___t__Q©- -__-- p __.._Distance from foundation__ � Disposal Field: Distance from nearest well�- _ �___ __________Qistance to nearest lot line___ -_______._ Number o7' lines-------_ � fi _'~ " ..� A Length of each line----------- --r`i Width of trench ._k� Type of filter material___�i�e'� ---Depth of filter material__! --------------Total length___J. -------0______________________ Seepage Pit: Distance to nearest well ________________-----Distance from foundation--------------------Distance to nearest lot line__.__.---".___ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth---.---------.------------------- Cesspool: Distance from nearest well-----------------Distance from foundation------------------- Lining material--------.___-______._______-__-_-.___ ❑ Size: Diameter-------------------------------------Depth-----------------------------------------------------Liquid Capacity----------------------------gals . Privy: Distance from nearest well-------------------_-----------------------------Distance from nearest b0ding------------------------------------------ F-1 Distance to nearest lot line----------------------------- - Remodelingand/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)-- (Owner and/or Contractor) ^1'�r -a- - --- - ------------------------------------------- ---------------- 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 ATE-------------------------- REVIEWEDBY------------------------------------- -------------- --- --------------------------------- DATE_/,>._ `%S BUILDING BUILDING PERMIT ISSUED--------------- ------ DATE Alterations and/or r ommendations:------ '� -------------^----------------------- rC t .¢_• „l .4 Q - -' ----- ----- - ---- ----- - -------------� ------------------_-- -- --- - ------ --- ---------------------------------- ---- 12l � �FINAL INSPECTION BY:. Date-- SAN --- 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