12789 - Laserfiche WebLink

Home Browse Search

I i''0 3 Z t APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued f.._..... 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 AN CATION.- -------------------------------------- Owner's Name --- - --- --------------------- -- ------------------- Phone----------------------- i Address ------ Contractor's Name---------- ------ Phone----------------------------------- Installation will serve: Residence – Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _.j_-__ Number of bedrooms ___1__ Number of baths ----I- Lot size -----46.0_X_1Q2?--------------____________ Water Supply: Public system ❑ Community system kf Private ❑ Depth to Water Table .�ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay X Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes V No ❑ FHA/VA: Yes ❑ NOV TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septi Tank: Distance from nearest welljA.4–__.Distan a from„foundn____-Ae..._..Ma�trial____ ____________________� No. of compartments__� --___._____ ,_--Liquid de th__.-__-_ ''�____Capacity... Disposal' Field: Distance from nearest well_ �Q_ Distance from foundation__ __ t___.Dista ce to nearest lot line__X____--... '11 r Number of lines_________________________________ Length of each line..?O__�-7 I of trench-_._-_-2–t,4__-_____._________ Type of filter material. —_ Rpth of filter material----)-4----------Total length--------k5_04b..I----------------- 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-------------------------------------- El ___ ______________________________.❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity_--------------------------gals. Privy: Distance from nearest well-----------------------------------_-------------Distance from nearest building------------------------------------------ 1-1 Distance to nearest lot line---------------------------------------------------------------------- �p Remodelingand/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. (Si ned °^ 9 ) =.�'7��=-.�'`--- - -=---- ---•---- �"" .__---(Owner and/or Contractor) =�'---------------------- -----(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 APPLICATIONACCEPTED BY---------------------------------------------------------- ---- -- •-- ---------------- DATE------------------------------------------- REVIEWEDBY--------------------------------------------------------------------------------- -- --------- ------------------• DATE----------,,•�- - ,.t- ? ------------- BUILDING PERMIT ISSUED-------------------------------------------------------- ---- ----- DATE----------------------------�------------ Alterationsand/or recommendations-----------------------------------------------------------------------------------------------•---------------------------------------------------------------- ----------------------- ---------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------•------------------------------------ f -----------------------.------------------------------------------------------------ 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 ES-9-2M Revisea 1.57 F.P.CO.