4373 - Laserfiche WebLink

Home Browse Search

Permit No. _ �?.__. ' APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Date Issued _1� tication is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. Thi s.'application is made in compliance with County Ordinance No. 549. ` --------------•--- JOB ADDRESS AND LOCATION_____---f�--�--; , - ---------------- - Owner's Name Phone ------ ------------------------- Contractor's Name---- ------------------------ ----------------------------- Phone--.. D(a s ------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: 1---- Number of bedrooms ---X. Number of baths __ Lot size __________________ _____________•--------- ------------ ----- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table "_ ft. Character of soil to a depth of 3 feet: Sand F1 Gravel ❑ Sandy Loam ❑ Clay Loam [I Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No g New Construction: Yesx No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) A I / Septic Tank: Distance from nearest weld ---,____Distant from foundation__. ___Q Mater��l-----------------------------p- ------------ i No. of compartmenfs-- ---------- -----------Size--- ` VA!"_''"-----Liquid depth-__ Capacity G SP1- �i � Distance to nearest lot _-..--- Disposal Field: Distance from nearest wellip�--_._Dis#ante from foundation______ _____ a s- - ------- Width of trench-------;2J/----------- - 0 Number of lines__'-----------------------------Length of each line_______-_____ �� , Type os` filter material-S.__R?94A'___Depth of filter material-----/r.�.:_____-.Total length---------- - -------------------------0, Seepage Pit: Distance to nearest welL._�O_!- _____,Distance from fo ndation__- _��______.Distan�eto nearest ) line_________________ .. / r Size: Diameter-------�4----- mat Deaptn----- -------------------- Number of pits----- ------------ -Lining material--- ------�----_-. tion-----------------.Lim Cess ool: Distance from nearest well_________________Distance from founds g els. I ! P ___-_-Li Liquid capacity-. ❑ Size: Diameter---r ----------- ------------- ----Depth------------ -----•---- ------------------ q ------------------ -- 9 �. ' Privy: Distance from nearest well__----------------------------------------------Distance from nearesf building---------- ------------------------------- ------------------- --______--------------------. ❑ to nearest ------ Distance ------------------------------------- - --------------------------------=------------------ Remodeling and/or repairing (describe):----------------------------------------------------------------------------------------------------------------------•----•------------------------------- ------------------- ------------------------------------------------------------------------------------------------------------------------------ ------------------------------ ------------------------------- ----------- l ------------ --- -------------------------------------------------------------•----------------------------------------------------------------------•------------------------------------------------------ -- _-.------ 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. i (Signed) (O ner and/or Contractor) ------ -- ----------- --------------------------------- ----------- ---- BY:--------------------R-4--a ---------------(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 01 APPLICATION ACCEPTED BY_________________ ____ �- DATI= ---- '- -------------------- l REVIEWED BY--------------------------------------- ----------------------------------------------•------------ --------------- ------ DATE----------------------------------------------------------- - BUILDING PERMIT ISSUED------------------------------------------------------------------ --------------------------- DATE--------- -------------------- ------------- --------------- Alterations and/or recommendations-------------------------------------------------- -----•-------------------•----••-----••------- -------------------------------------- ----------------------------- ______________________ _________________________________________________________________________ r t _____________________-______--_--___-___--_____-_- _ _________________ ______________________________________________________________ ------------_-------------------- t9 i a FINAL INSPECTION BY-------------- - ------= Date-------�--- -- ----- ------------- l f 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 10-52 Revised W-2100