11672 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. .. I __./-_ (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 wi County Ordinance N _ o. JOB ADDRESS AND L ATION-_--1 _- --�----- .�-------------------k �i�l Ir1 '/ A 7 Owner's Name-------- ----- ------- -- /- ----------- Phone----p----I--C-J �AB7Jnly, iAddress l3 'Cf ---------- � O1J G Contractor's Name----- 14 /v. -+ ----------------------- Phone------ -----•-----•--------------- ---------------------------------------------------------------------------- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms Number of baths ___l__ Lot size ----- ------------------ Water Supply: Public system ❑ Community system ❑ Privateo Depth to Water Table_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy;Loam ❑ Clay Loam ❑ Clay ❑ Adobe P( Hardpan ❑ Previous Application Made: Yes ❑ No 12� New Construction: Yes ❑ FNo) FHA/VA: Yes ❑ No�< TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) jJ Septic Tank: Distance from nearest well_____-Dista e from fo ndation_______L_�_____-Ma erial____- �� No. of compartments.____v2-.____________Size_YX� �___.___Liquid depth__________ __ __Capacity___ . Disposal Field: Distance from nearer ell-- --` Distance from foundation-----l�J.___.____Distance to nearest lot line______-_--- . Number of lines___ ______Length of each line__-n 40 , 3.Width of trench__ ____ Type of filter materiW��- p / length-----th of filter material__-_.��-____________Total len th_____��_______________________ 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________________-_.__._____________. El Size: Diameter------------------------- ----- Dept Liquid Capacity - p q ------------- - -----• --gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----------------------------------------_- ❑ Distance to nearest lot line----------------------------------------------------------------------------------------------------------------------------------------- - Remodeling and/or repairing (describe)---------------------- --------------------------•---•---- ----------------------- ------------------------------------------- ------------------•---------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------•---------------------------------------------------------------------------------•-••-------=----=------------------------------------------------------------ -------------------------------------------------------------------------------------------------------------------•-•----------------------------------------------------------------------------------------------- -------- 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 rules and regulations of the San Joaquin Local Health District. (Signed)--:t�__. � ---------------------------------------------------------------------------------------------------------- Owne a d/or Contractor) BY:----------------- ------------•---------------------------------------------------------------------------------------------------(Title)------------•--- =r (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). f FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------ - - -- ---------- ---- -- - --- --------------•------------------------ DATE------------ REVIEWEDBY--------- ----------------------- ----------- --- -- - - ----------------------------------------------------- DATE------g------------ -R BUILDINGPERMIT ISSUED---------------------------- -----------------------------------------.- DATE------------------------------------------------------------ 1 Alterations and/or recommendations:- -----------------------------------------------------------------------------------•--------------------------------------------------- z '►'y - - 02.C," � -----0----- k+'�--------e-t +,,,--•--- *,-Q tnQ ---------------------------------------------------------------------------------------------------------------------------(v FINALINSPECTION BY:--------------------------------------------------------------- Date------------------------------------------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 30D West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California . Lodi, California Manteca, California Tracy, California !:5 9-�--2M , Revised 1.57 F.P.CO.