10914 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. Jff_I- �-�- (Complete in Duplicate) "Y Date Issued ._ ,SAY 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. __ * _.. .1._ ------------------------------------ JOB ADDRESS AND LOCATION____________ -- -- - "" Owner's Name -------------- --------------- Phone_-------•--------------------------- � � o- Address - ---------------------- ---------------•------------------------ ------------------------------------------•- Contractor's Name---------- ----- - -------------------------------------- Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel Other ❑ Number of living units: -_, __ Number of bedrooms -/-___ Number of baths -/---- Lot size ------ ------------------------ 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 V Previous Application Made: Yes F1No New Construction: Yes ❑ No ❑ PHA/VA: Yes El No El TYPE OF INSTALLATION AND SPECIFICATIONS: 1 (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) L' Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material--------------------------------------_-_______- 1J&—No. of compartments------------------------Size-------•-------•----------------Liquid depth---:---------- -----------Capacity----------------------- Disposal Field: Distance from nearest weld_____ _________Distance from foundation___--_____-_____--.Distance to near stfat4n�e__ --------- Number of lines---•-------------- ---------------Length of each line------------------------------ Width of trench ---- Depth of filter material _______ ______ _____Total length___. Type of filter _- material-_____________ Seepage Pit: Distance to nearest well___-_-.Mance fro fou'cl ze n-----meter -Distan/tonearestlomat lin+ ----- ----------- - . Number of pits_____--_ _Lining material____ . 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 line-------- - ---- -------------------------------------------------------- ---- ---- Remodeling and/or repairing (describe---------------------------------------------------_--------------------------------- ------------•------------------------ ------•--------------------•---------•---------- -----•- ------------------------------------------------------- 4 - fi ---------- i I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Count ordinances, State laws, and rules and lations of the San Joaquin Local Health District. y (Owner and/or Contractor) . (Signed.. Tale (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 �- ' ------ DATE---'-?r- -- --- '---- ----------•--•------------ APPLICATION ACCEPTED BY----��.�_�� ----------- ----------- --------------------------•-- REVIEWED BY------------------------- `---- -- -- DATE -------- BUILDING PERMIT ISSUED-----•--------------- ----- --------------- DATE------------------------------------------- Alterations ----------------Alterations and/or recommendations:------ •---------- ------------------•------------••---------------------•--- •-------._.. �-� ----•-------------f----•---•--------------------••----------- ---------------------'----f -------------------- -- __ - `--' -------fix------------- ----- --- - -------------- ----- --- - -------- ------ ----------' - / , - - ,�/y ,� - �1 i fi t ----- FINAL INSPECTI Date[_ ----------------- t SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Tracy, California Lodi, California Manteca, California ES-9-2M Revised 1.57 FY-CO.