3364 - Laserfiche WebLink

Home Browse Search

APPLICATION Permit No � C ON FOR SANITATION PERMIT ��--------- M1 � �� (Complete in Duplicate) V v ` y� 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. JOB ADDRESS AND LOCATION--------- `------------ >--- --------------------------------------- . / Owner's Name ------•---•----------- -- -- ------------------------------- Phone---s=!_. _1 --------- Address--------------- ---------------------. ---------------------------- Contractor's Name--------------------------------- - ------ Phone----�'.-_g_6 ------- Installation will serve: Residence a Apartment House ❑dd Commercial El Trailer Court ❑ Motel El Other E]Number of"living units: A?--- Number of bedrooms _-Q_-- Number of baths ----Y Lot size _____7 -------- Water Supply: Public system X Community system ❑ Private ❑ Depth to Water Table loft. Character of soil to a depth of 3 feet: Sand 0 Gravel [:1 Sand y Loam ❑ Clay Loam [] Clay ❑ Adobe„(] Hardpan ❑ Previous Application Made: Yes ❑ No B"_ New Construction: Yes ❑ No ❑ r� ° 7 ; TYPE OF INSTALLATION AND SPECIFICATIONS: r- (No septic tank or cesspool permitted if public sewer is available within 200 feet.) tictic Tank er Distance from nearest'weil_________________Distance from foundation__-________-_____.Material-___._._________._.____-_.--___.._-----...______- No. of compartments------------ - -----------Size---------------------------------Liquid depth--------------------------Capacity----------------------- Disposal Field: Distance from nearest well--'(0Pl1'_Distance from foundation----/_a�.......Distance to nearest lot line_/Q'-_____ Number of lines___.____�1__...._________ __ Length of each line_____��fa r_.___._._.Width of trench.__. _Y_"._______-_____, Type of filter material.____�_��-�_{ _Depth of filter material----- "______Total length__�__-________________________� Seepage Pit: Distance to nearest well.__ --._._Distance from foundation__ __�______.Di t �e to nearest lot line______'_ 0, Number of pits--------.--_________Lining material__5___�____��6---Size: Diameter____�--------Depth__ '_____________ Cesspool: {Distance from nearest well----------------- from foundation---------------_____Lining material------------------------------------- 0 _-.__'_--_--_--- _.________❑ Size: Diameter-------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals, Privy: Distance from nearest well--------------------------------------------------Distance from nearest building-------------------------------._____.__. ❑ Distance to nearest lot line-- ------------------- ---------------------- - -------------------------------------------------------------------------------------------- -------------------•----L------------------------------------------------------------------ Remodeling and/or repairing (describe)------------------------------------------------------------------------------------------------ ------------------------------- -- -- ---- --- -- --•------------ -•--------------- -------------------------------------- ---•-----------------•---------------•---------------------------------- I hereby certify,tJ�at 1-have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State lag's,hand rules and regulations of the San Joaquin Local Health District. ---- (Signed) -- --------------------------------------------------------$5,4!zContractor ay:._..._.. -- - - � -------------------------(Title)----- (Plot plan, showing size of lot, location of system in re a�Fion to wells, Vildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- --------- ------------------------------------------------------------------------------- DATE--------------------------------------------------- REVIEWED BY-------------------------------- -- - ------------------- --------------------------------------------------------- DATE--- BUILDING PERMIT ISSUED------------------------------•---------------------------------------------------------------------- DATE------- UN-------------------------------------- Alterations and/or recommendations:-----------------------------------------------------------•------------------------------------------------�----------..--------------------------------- -•---..--•----•----•---•--•--------------------•----.--------------•---------- '7 --------------------------------------------------------------------------------------- •-- ---•---------------•-----•--------------- ----------------------------------------------------------------------------------•--------------------•---•-- ------_-----------------•---•----------------------------•--•--------------------------------------------•--- ------------------•--------- ---- -------------------------------•-------•---------------------------------------------------------------------------------------------------------------------------------------------- FINAL INSPECTION BY:----------c�--------------------------------- Date---/-XV. - ?+ 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