3987 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No_ ----- _------------------ (Complete in Duplicate) Date Issued j_pY!-=r3 r Application is hereby made to the!San Joaquin Local Health District for a permit to construct and install the w56 herein described. This application is made in compliance with County Ordinance No. 549. r . JOBADDRESS AN LOCATION-- ------:--------------' a------ ----------------------------------------------------- ------------------------------------------------ 7 ��: . . J�'C! --------------- Phone------------------- ----------- Owner s Name-----(- •---------"�/" - -------- Address ,/ � i f to cf ---------------------------------------------------------------------------------------------------------- i Contractor's Name---------Y'` �-' --- Phone ``- -------- Installation will serve: Residence 9� Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: . ____ Number of bedrooms _--_ Number of baths _�.____ Lot size __��_-�----.J_=--��_=--/--------------------•- 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 Z Clay Loam ❑ Clay ❑ Adobe❑ Hardpan _ `-� Previous Application Made: Yes El.' No New Construction: Yes No ❑ R TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest wel__.5-10'1 -'Distance fro foun ation:4 _!t"'MateriaL�. �/ ��oo Liquid dept Capacity---- No. + n of compartments___-- -----------•-�-Sl/s - lf} -- q �� Dispo `I Field: Distance from nearest weil__�P__PF!_.Distance from foundation--- - __Distance to nearest lot line_ 7 Number of lines------------•----------------------Length of each line------------------------------Width of trench----------------------------------- Type of filter material----- ------------------Depth of filter material-----------------------Total length---------------------------------- ---- Seepage 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__-_____-___-----__________---____._ ❑ Size: D.iameter-------------------------------------Depth----------------------------------------------------Liquid Capacity----------•----------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ ❑ Distance to nearest lot line--------------------------- -------------------------------------- ----------------------------------------------------------------------------- Remodeling and/or rep'airirig(d`as-HIJ- ---�" ---------- ----------�----------------- -�-- ---- -------•----_-_....--------------- --------------------------- ---------------•--- ----•-•---------------------------- ; ----------------------------•----------•-•-----------------------------------•---------------------•-- -------- -----------------------------------------------------I---------------------------------1-1----------- -----------------•--•----------------------------------------------•-•----------------•---------------- 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 r les and regulations of the S n oaquin Local Health District. ______________ (Owner 'and/or Contractor] yr (Signed)_ Z — --------•---�`-�J--------------- rBy:-------------------------------- -------------------------------------------------------- ----------------- ------------------------(Title)--------------------------------------------------------------- (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 APPLICATION ACCEPTED BY--------- -- --- --- ---- --- --------------------------------- DATE ��------=----------------------------- k REVIEWED BY------------------------------ DATE BUILDINGPERMIT ISSUED---------------------------------- -----=---------------------------- DATE------------------------------------------------------------- Alferaiions and/or recommendafions------- ----------- ,r-------------_------------------------------------------------------------------ - -------------------------------------------- --------- ------------------------ -------------------- ------- -- - Ito AlO -- A---j 6 - - __/40 -- ------ ----9,,-/----- -------- ------------ ( �'!' , t , -----7_�-- .� . -.� _._.__G/�.---;�� ._ s� ee 0.14-11k x # FINAL -INSPECTION BY-------------------- -------------------------------------------- Date--- -------- J. ------ - E J SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California- Lodi, Chfifornia Manteca, California Tracy, California ES-9-2M B-51 Revised W-2100