7508 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT ' -= Permit No. ..._---_._•_____________ �fi � (Com I to in Duplicate) r �JI, Date Issued --------.....---____-- 44= 5 I V 22-5-o.- V Z..o" oz- Y Applica{ion 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 w.i. County Ordinance No. 549. &nel,41-------------- ---- JOB ADDRESS AND CATION - -----------------r 'F ' hone Owner's Name ------)�_ -- ---•- / Address.- --ice in----------�' -'--------•--:---------------------------------- ----- -------------------•---------------------- Contractor`s Name----------- ------•----------•----------------------- ------•------------------------------------------ Phone l 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 fee+: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardp ❑ 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__;._--_______._Distance from foundation-------------------_Material__.__________-____________________.__-__._-_-_. ❑ No. of compartments--------------------- ----Size--------------------------------Liquid depth--------------- - --------Capacity----------tZS Dispos I Field: Distance from nearest welL__!._-:r-U_Distance from foundation____._ _.Distance to nearest lot line._,r__________- Number of lines___._-_-f__..._._.___----- ---Length of each line-----�r 4 �l Width of trench_._.___��__ ____________________ •� ' ype or filter material___ !��-_Depth of filter material_-_—ISr: __..Total length------ _____________________ eepage 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--_-_------________._____________. _ ID Size:,Diameter-------- --- ------------------- ---=Depth------.----- -------------------------------------Liquid Capaci ty- ----•------------------gals. -- Privy: Distance from nearest well--------- --------------------------------`-.-Distance from nearest building------------_----------------------------. ❑ Distancettonearest lot line---------------------------------------------- ----------------------•------ --------------------------------------------------------------- - �- r Remodelingand/or repairing (describe)---------- --------- --------------------------------•------------------------------•------------------------------------------------------•----------- --------••--------------•-----••----------•----------•----------•---•----------••------------•----------------------------------------------------------•---------------- ------------ ----------- ----------------------------------------------------------------------------------------------------•--------•------------------------------------------------------ I hereby certify that I have prepared this application and +hat 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. Owner and/or Contractor By:. - --- ---- ---- ----orli------------------------ --------�----------- '-----------------------•------------{Title)---------------------------------------------------------------- {Plot plan. showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). k FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY--------------------- -- ------------------------------------------------ ---- DATE------------------- ---- REVIEWEDBY-------------------------------- ------------ DATE �( > •-f ------------------- ------- ---- DATE--------------------------•------------------- -------------- BUILDING PERMIT ISSUED-------------- � ----------------- -------------- r Alterations and/or recom gn alions------------ - •- --�------ �----------••----------•--- ----- --- } dk r� --------- -- -- - - -- -- -- - - ._ � --------------------•------------•----------••------•--------------------------------••----- -------------------------------------------------------•---- ------ + 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 E'- 9-2M {45146 ATWOOD 12.54