2370 - Laserfiche WebLink

Home Browse Search

.k - ,' APPLICATION FOR SANITATION PERMIT Permit No.:ZIP (Complete in Duplicate) 3� S 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 Ordinance No. 549, JOB ADDRESS AND L ATION-----Z C --- ---( ---------- -- -- -•--- -- -- ---- ----------------------------------------------------------j--�---- - ----------------- Owner's Name. ---------------------------------- --------- ---------- Phone---------------------------- Address ---'"f_ 1----�-- Address-------------• � Contractor's Name-----------•--------------- ----- ------------------------------------------------------------------------------------------ Phone----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: I---- Number of. bedrooms _____ Number of baths _1_____ Lot size _____ _ �________________________ � Water Supply: Public system ommunify system ❑ Private ❑ Depth to Water Table ________ it. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam 0 Clay ❑ Adobe[g_Uac.dgan_❑a-�i Previous Application Made: Yes ❑ No ❑i'N Construction: Yes ®—"! _0 ff__ �A TYPE OF'INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest wellOV011-°_Distance from foun�lation----C_Qt______.MateriaL_ __-___________"__________________f______- No. of compartments______-__0_'_ -___Size___ __ _______Liquid depth____ _--------------Capacity.___ 1. Disposal Field: Distance from nearest well---------------..°Distance from foundation-.40_'L'__-_-Distance to nearest lot line___._-..___. Number of lines_-___`----- ---------------------Length of each line--------- Q------------Width of french______t7 �� ----------------•-- Type of filter mater iaL____1_ ___ Depth of filter material_"�__5_____---.-_Total length---- �_�l__ "---___-_- Seepage Pit: Distance to nearest well--------_-------------Distance from foundation_________________-.Distance to nearest lot line__-____________-- ❑ Number of pits----------------------Lining material----------------------.Size: Diameter------------------------Depth---------------------_----------- Cesspool: D] stance from nearest well__________-_____Distance from foundation--------------------Lining material--------"--_--------_---------_.__--_. ❑ Size: Diameter------------------- ------Depth ------ ------ ------------Liquid Capacity-------------.--- ---_gals Privy: Distance from nearest well __.-___ __-___- -------------- ____ „,,...� Distance•from nearest" building --------------------------------------- 0 ---" ________________________________ ❑ Distance to nearest lot 1ine---------------------------------------------------------------------------------------------------------------------------------------------- Remodeling and/or repair'nq {describe:- -`� �1t�_,_ __-` ------ - �-.-----' 4 =------------• --- ---------------- �- �--------- ------------------ -��---------------------------------------------------- ------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ I hereby certify that ave prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State la s, a d ules/and �regulations of,the San Joaquin Local Health District. (Signed)----- `�/� ___ �� __________________________ ____Owner and/or Contractor B -------------------------- ------------------=-----------------------'---------------------------------7-------------------------(Title)---------------------------------------------------------------- (Plot pl n showing size lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- - --- r_ --------------------------------------------------------------- DATE-------- ---_• -- _-C-7-_-.---------------------- REVIEWED BY-------------------------------------------- ----------------------------------------------- ----------- DATE----------------------------- ----- - -- ------------------- BUILDING PERMIT ISSUED-----------------•---------------------------------------------------------------- DATE------------------------ _ -------------------- -------•----- Alterations and/or'recommendations------------------------------ --- -------------- ----------------------------------------------- --- �;p----------1_r -------------------------------- ------ ------------------------------- --------! -- ----------- --- ----- ----- ----- - ------------ ------- -I ----- ----- -•---- I(;--r-------`------------------ -----------•--- l i � -----•--------------------------------- ------------------------------------------- ------ - ------- -------------- --------------------------------------------------------- -------------$Pk------------ -•----------------------------------------------------------------------- -- --------- ---------------------------------------------------------------------------------------------- eq RNALINSPECTION BY:- Tip`---------------------�-------- --- --•- Date---------------_!__-----------------------------------------•---------------- SAN JO� ?UIN L CAL 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 8.51 Revised W-2100