4820 - Laserfiche WebLink

Home Browse Search

lv 1 APPLICATION FOR SANITATION PERMIT Permit No. . __Q__rYO (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 Ordinance No. 549. 7 --------------�Ll7 -------------- --- - ------------------- -------------------- JOB ADDRESS AND LOCATEON---------��1�� 4 ---------------- ------------------------- Owner's Name---------------------IMe tw---t------------- ------------------- -------- ----- Phone------------------------------------ Address--------------------------------------------------------------------------------------------------------------------------------------------------- Contractor's Name----------------------------------ht----+ --&__ilzf)--------- ------------------------------------------------------------------- Phone---------------------------------- Installation will serve: Residence O Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel Q Other ❑ Number of living units: ________ Number of bedrooms __Z_ Number of baths ____i__ Lot size ---------Sv�__ _� .Q----______________________ Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeJP Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: 'I (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r Septic Tank: Distance from nearest well-------ft------Distance from foundation-----10---------- Material-------- fir ve -------------------- _. No, of compartmenhs----------7_.----------Size---S~_X__ ------Liquid depth___________�.).L.'__-__--Capacity______c�s�_ B }_,� o Disposal Field: Distance from nearest well____i-____-_-Distance from foundation______1L1.__------Distance to nearest lot line-------,______ Number of lines------------------ Length of each line_ °-�S_`ys" O_.Width of trench----------z��_.___._______._ Type of filter material_______ - of filter material___.____jt`�___.____Total length___-..__/_�________________________ Seepage Pit: Distance to nearest well----------------------Distance 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-_-_____.___-_______._________-______- + ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ ❑ Distance to nearest lot line-------- -------- --- --------------------------------------------------------------------------------------------------------------------- Remodeling and/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 and regulations of the San Joaquin Local Health District. (Signed)------------------------------------------------------------------------------------------ -------------------------------------------------------------- --------(Owner and/or Contractor) Y� -----------------------------------------------------------------------------------------(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 APPLICATION ACCEPTED BY------------------------------- - --- DATE----------- -js�------- --- -- ---------- -------------------------- --------------------- REVIEWED BY DATE--------� --- ------ ----.•-- ---------- BU1LDlNG PERMIT ISSUED DATE------------- ---------------------------------------------- ------- ------ --------------------------------------------- Alterations and/or recommendations-----------------b---------------------------------------------------- --------------------------------------------------------- ----------------------- --------------------------- --------- - -------------2,f -----7 -------------------------------- r-- -------- .---------------- Cd r` FINAL INSPECTION BY L------ --- --------------------- Date-- --- ------ ------ - ------- ---�------------------- 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 E5-9-2M Revised W-2100