7892 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. _.1. ---------------- (Complete _----•_y(Complete in Duplicate) ' 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. J08 ADDRESS AND LOCATION--------- ----- Owner's ----Owner's Name-------------------------------------- L12 ------- ----�0[1/ 7--------------------- Phone------------------------------------ Address--------------------------•--------------------- Contractor's Name----------------------------- zrk----' rj ------ Phone------ ----•- Installation will serve: Residence J' Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: /____ Number of bedrooms __Number of baths _�A- Lot size ------ff-iP�_ C-/�-1P*----------------------- Water Supply: Public system X Community system ❑ Private E] 'Depth to Water Table _A10- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe%f Hardpan ❑-,I;*-, Previous Application Made: Yes ❑ No JK New Construction: Yes ❑ No ❑ /, 4A. - TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) is Ta k:r Distance from nearest well_________________Distance from foundation--------------------Material __________.___________________________________.`� No. of compartments______________ __Size_____.-._____________ v `"'"j ------� -----------Liquid `eptly--------------- -----Capacity------ -------------- Disposal Field: Distance from nearest well___ ___Q____----Distance from foundation---9------------Distance to nearest lot line___3______,.. Number of lines,-------- __________-- _ Length of each line_______!i°�P,'-----------Width of french---�_�'� -- -- --------------------- Type of filter material - -_ Depth of filter material____Ile-"-------Total length---- 1 Seepage Pit: Distance to nearest welL__�© ______Distanc fr m foundation---L_Q,----__-Dis an ce to nearest lot line___,ti-- i___ XNumber of pits-----_-/------------Lining material_-------••---�-----Size: Diameter____________ ________Depth___s s __-------------_--- 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-------------------..__________----.___._-- ° ❑ Distance to nearest lot fine ----------------------------- ------------------------------•---- ----------------------- --•----------•------------------------------ 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, rules and regulations of the San Joaquin Local Health District. {Signed �.)------------ ---------------------------------------------- Contractor) By%-- • ------- ----- ------------------------------(Title)---- -� -/?----------------(Plat plan, she ing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). k FOR DEPARTMENT USE ONLY s APPLICATION ACCEPTED BY------------ _ DATE IREVIEWED BY -------------------------------- --------------------------------- - ------------------------------------------- DATE--------- ------- ----- ------------------------ BUILDING PERMIT ISSUED DATE Alterations and/or recommendations------- --------------------------------- ) --------------------------------------------------------- ------------- ------------------------------------------------------------------------------------------------------------------------ ----------------------------- -------------------------------------------- 1 ------------------------------------------- --- FINAL INSPECTION BY-----------------1----{- - - ------------------------- Date-- --------�)-I-q.-- - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Stree+ Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 8-51 Revised W-2100