8315 - Laserfiche WebLink

Home Browse Search

1� APPLICATION FOR ANITATION PERMIT Permit �r,.—,"- "` (Complete in Duplicate) / Date Issued 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 with County Ordinance No. 549. JOB ADDRESS AND LO ATION .J. lt '` ----------- ---- Owner's Name--- 'y --------------------------•-------------------------------- --- ---------------------------------------- Phone_ �.,�44 .---f Address {-..---•------- -------------•---------•----------------------------------------------------------------= ---------------------------•--------- ------------ Contractor's Name------� �--- ---• ----- Phone.---1 3 �J_! ---------------------------------------- -------------------------------- Installation will serve: Residence 0�?''Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: _Z_ Number of bedrooms !TA-- Number of baths - r_- Lot size ___. .____-__2-" __._______________________ Water Supply: Public system [Community system C] Private E] Depth to Water Table _ __._. ft. Character of soil to a depth of 3 fee+: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [[Hardpan ❑ Previous Application Made: Yes ❑ No Q New Construction: Yes V 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 ___._______.________________.__._____.________. I No. of compartments-------------------------Size--------------------------------Liquid depth--------------------------Capacity----------------------- Disposal eld: Distance from nearest well__________________Distance from foundation------------------------Distance to nearest lot line-___________..___ (� Number of lines------_---------------------------Length of-edch line--------------------------_Width of trench_----------_---:------------__.--- " Type of filter material----- -------_---------Depth of filter material______�___-�DTotal stance tgthnearest lot li ------- Seepage Pit: Distance to nearest well__--�_�- .. D-ssstancp fRom foundation_._ Number of pits______.__._________Lining materia Ll ►________--Size: Diameler_ __--a�"`pepth_--___� ---__.-_______- Cesspool: Distance from nearest well-----------------Distance from foundation---.------------.---Lininggaterial____________:y__._ - ❑ Size: Diameter--------------------------------------Depth------I-------- -- -•-------------------------------Liquid .Capacity----•- _----------•--------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----------------------._______.________- ❑ Distance to nearest lot line---------------------------------------------- Remodeling and/or repairing {describes------------- - --- ------- ----- - -° ------------ ------- --` ------------------•---------------------------------------------- .�.., ------------------------------------------------ --------------------------------------------------------------------------------------------------------------------------------------------•-.-------------------------------------.------•------------------------------- -------------------------------------------------------------•-----------------------------------------------------------.--------_----------•--••-------------------------------------------------------------------------- I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws,�a-n-�d rules and regulations of the San Joaquin Local Health District. (Signed)'�� _ '-- _----------------------------------------------------------------------------------------------------- -------------(Owner and/or Contractor � CL io -- - ------------------------- (Plot plan, showing sizet, location of system in relation to wells, buildings, etc., can be placed on never side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- ---------------------------------- DATE ? --------------- REVIEWED BY ----------------------- ----- ---------------------------------------------- DATE- BUILDING PERMIT ISSUED --------------------------------------------------------------------------------------------- DATE----- --------- Alterations and/or recommendations--- ------------------------------------------------------------•---•-------------------•--------•-----.._..... ---------------------- ::: ::_:: _._ ________- _---__ __ :____::________:_____--_-______------___:_________----------- -----------------•--------- -- ----------------------------------------------- ---------- -------------------------------------------- --------------------��--------------------------•------------------------------------ 449�� FINAL INSPECTION BY:.------- - - --s----------------- ------ Date---------)- -l--- •-- - `� SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Sfreet 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-21v1 Revised W-2100