2105 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. y (Complefe in Duplicate) , f f�� Date Issue __________________ 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 L CATION_... . _ - �f -•---- - -----------------------------------•---- Owner's Name___A/V i ----- --------------------------------------- Phone------------------------------------ --------- -- ---- ---- - - -- - - - ------ Contractor's Name______ __(;` ••.____ _ - Phone_ '___ - --------------- Installation will serve: Residence ❑ Apartment House ❑ Commercial V] Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ._ Number of bedrooms-_ Number of baths .4--- Lot size _____(�-_�-� �- --- --- --- -------------------- Water Supply: Public system o-rnunity 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 Flo ❑ 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-'f ________Distant fyom f und�ti n____ �y _� �` �-�--------Ma#Trial---- -- -VW_-----------�-- El,o No. of compartmerrFs-------- ----------Size-�__ _ Liquid depth----l- ------- ---------Capacity_. ---- Disposal Field: Distance from nearest li__ ___________Distance from foundation,__ ____Distance fo nearest lot I e____ � DP-- Number of lines--__ Length of each line___ __ Width of trench_- • ----- J------------ Type of filter material- �-_ _�--Depth of filter material__ ............. length_____ ____ d �/-- ---------•--------•- Seepage Pit: Distance to nearest well---------------------- 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----------------------- 1-1 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):-------------------------------------------------------------------------------------------------------------- -- -----------------------------------------------------------------------------------------------------•----------------------------•---------------------------------------------------------------------•-------------- 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. ir" (Signed) ' ��" ' ,�--- ,,, �f _• •, ( {Owner and/or Contractor) 1740 By: i - - -- ----------------------------------------------------------------(Title)------ s.✓ -------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be place t!averse de) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- ------------- DAT£ ------------------------------------------------- REVIEWED BY------------------------------ DATE--------7 BUILDING PERMIT ISSUED ---- ---- ----------------------------- ---- Aljteerati s and/or recom endations: ---F----- DATE l _ --- - - e_- I- ------- ------- - R r _ late ------------ ----- --- - ------- - - --- ------ ---------------------- ---- ----------- ----- --- - -----------------------------=- I---------- - - ------------- _ --------------Date----... --------FINAL ------ ----- ------------ ------------ --------------------- FINAL INSPECTION BY:-- = --- 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 8-51 Revised W-2100