2627 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit N -- (Complete in Duplicate) Y 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 ith CounfyjOrdi Ince o 549, JOB ADDRESSI LOCATIO -- 1 ------- -- - -------- - -- --- ---------- ------------------------------------------------- Phone. '1 Owner's Name------ -------- �• Address---- - -------------------------------------------------------•-------------------• ------------- ---------------------- .... Contractor's Name-- ---------• ------------------------- Phone ----------- Installation will serve: Residence Apartment House Commercial ❑ Trailer Court ❑ Mo++el ❑ Other E] Number of living units: ---I-_- Number of bedrooms __ Number of baths J---_ Lot size __ .(/-_. __� ----------------•------- Water Supply: Public system ❑ Community system ❑ Private'1M/Depth to Water Table --------- ft. Character of soil to a depth of 3 feet: Sand Q Gravel [I Sandy Loam Clay Loam El Clay ❑ Adobe Hardpan E]P ; �,/ Previous Application Made: Yes El No k� New Construction: Yes e No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feeef�. j Septic ank: Distance from nearest well_ .____Dista elf�r/o fund ____I:�_____-_.Mate `�..............._______.... _-.-._ ---- No. of compartments_--------- ---. --Size-- - -"Liquid dept -------- ----------.Capacity.. .f!/---- i Dispos Field: Distance from nearest well__ 0___.Distance from foundat-on..... _ - Istance to nearest to in t ----------- Number of lines---- �y ngth of each line--4-."sa�_. _�+ _ idth of trench .------ - (--_------.-•- Type of filter mate riepth of filter material_------1-S_.._____Total length-_-----._-.e� ,lt ___.....___...__ 1 Seepage Pit: Distance to nearest well_____ _______________Distance from foundation_____-_----.____..-.Distance to nearest lot line----------------- P ❑ Number of pits----------------------Lining material meter Diameter-----------------------Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-_.-- -----_------______-____----. ❑ Size: Diameter--------------------------------------Depth-----------------------------------------------------Liquid Capacity-----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building______--__----_--_- , ❑ Distance to nearest lot line---------------------------------------------------------------- ---------------- ----------------------------------------------------------- F 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 an regulati s of the S n Joaquin Local Health District. 5i ned .-_---- .. -.- ----------------------- ----- ---------------------{Owner and/or Contractor) B - m_----f �" A/ --------------------------------(Title) }� (Plot plan, showing size of lot, cation 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 BUILDINGPERMIT ISSUED ------------------------ ------------------------------------- DATE-------------- -------------------------•----------- Alterations and/or recommendations--------------------------- - ----------------------------------------------------------------------------------------•--------------------------•------------- --------------------------------I--------------------------- ------------------------------- --------------------------------------------------------------------------------------------------------------- ------------------------ ---- -------- --------------------- ---------- ----------------- ----------------- FINAL INSPECTION BY:------- - - Date - 7 SAN JOAQU-IN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California 1 Lodi, California Manteca, California Tracy, California ES---4-2M 8-51 Revised W-2100 .��..—