9456 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) 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 Ordinan No- 549. f - =T___JOB ADDRESS AND LOCATION-i :___-.-'---.- - J� ` --------•-----------------•-------- - -------------------------------------- - Phone----------------------------- - Name------- �------ --- - ----•---- - -- -- �j G/ Address--------- - ---�----N e�..1--�o-j----------•--------- Contractor s Name----`--------------- ------------------------------- ------------ -- ------=---------- - - Phone_--_- Instaiiation will serve: Residence JA rtment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑' ti Number of living units: _--__._ Number of bedrooms _Z Number of baths --- Lot size - Water Supply: Public system ❑ Community system ❑ PrivateX Depth to Water Table Character of soil to a depth of 3 feet:. Sand E] Grayel I( Sandy Loam•[X Clay Loam ❑ Clay E] Adobe..[:] Hardpan C] Previous Application Made: Yes X No ❑ New Construction: Yes No FHA/VA: Yes E] No,% TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) #� V _. I. . _. ,,.. Septic Tank: Distance from nearest well_:• _ .- _ Distance from fours tion__- _ _.Maten L� : Size__ iquid depth--------�----------Capacity �+3 -------- No. of compartments------- --. -- - -�-�� ,' r / � Disposal Field: Distance from nearest well__._(,?✓_-.._.Distance from founclation_____I_[?�---------Distance to nearest lot line_- Number. of lines-----/--------------- Length of each line--------f -+ . -� -W�dth of french-----Z-' r`_.-______ Type of filter material_5tDepth of filter material_-- _---------Total length-------.1_Z_�____________________ 1, Seepage Pit: Distance to nearest well_____________ ________Distance from foundation______-___-.____-_-.Distance to nearest lot me----------------- ❑ Number of pits----------------------Lining material---------- ------------Size: Diameter------------------------Dept'h Cesspool: Distance from nearest well ----------------- from foundation__'_--------- material-_._______________-______._-______ . El Size: Diameter :: - ------Depth= ---------- --------------- -_- -- Liquid Capacity------------------ = gals. r Privy: Distance from nearest well"-"------------------------------ - distance from 'nearest building------------------------------ ❑ -stance to nearest lot lire--------- -----------------•---- -- = Di ----"-- ------- -------------------------- ----------- Remodeling and/or repairing (describe)--------------------------------------------------- ------------------------------- -------------------------------------------------------------------•----- I -------------------------------------------------------- - 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, and ruleja ;regula2ons of the San Joaquin Local Health District.u ct(Signed).-- ---- � f r�<' ' ------------------------------- ------------------- ------- = - (Owner and/or, Contractor) ---(Title)----------------------- ----- ......... By:_------------------------------------------------------------------ ---------------- ----------- ----- (Plot plan, showing sire 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 , REVIEWED BY-------------=----` --------------------- ----- DATE /_ 4_" ; .1. DATE------------------------------------------------------------- BUILDING PERMIT ISSUED--------------------- ------ ----------------------------- ----------- ----- Alterations and/or recommendations:--------:------------------------------------------------------------•--------- •------•- --------------------------------------------------- ---------- •------------------- ----- --- ------------------------- --------- ------- ----------------- „F FINAL INSPECTION BY:_ ----- ---- --- -- Date--- -----/-J-/3-- ---------- ------------ -•-------------------•- SAN JOAQUIN LOCAL HEALTH DISTRICT 13o South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES, 22M Revised 1-57 FY CO: