3534 - Laserfiche WebLink

Home Browse Search

51"4v\ W Y APPLICATION FOR SANITATION PERMIT Permit No�S ___ r (Com lete in Duplicate) a �yA P Rate Issued ._ . Ld 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 Orclina�ce No. 549. JOBADDRESS LOCATION.._0_�_ '------------------ --- -- ----------•---------------- --------------------------------------------------------------------- IV Owner's Name,------- ` •- ----- -- -- -- --------- ------------- -------- -------------------------------------------- Phone-- Address---- __✓ s_.__. --------- Contractor's Name__. ri Phone Installation will serve: Residence f Apartment House E] Commercial 0 Trailer� Court E] Motel E] Other F]Number of living units: __(___.Number of bedrooms o3_- Number of baths _1____ Lot size ---- Y-3-1-0-1---------------- Water Supply: Public system 12/Community system ❑ Private ❑ Depth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy Lo;PNO Clay Loam ElClay E] Adobe �ardpan ❑ Previous Application Made: Yes E] No RI/ New Construction: Yes ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet) Septic/Tank- - Distance from nearest well____ _�istancp from found�ion/�__ _____Mater'all______________--_____ No. of compartments-------- - ------- - ze�__ Qiquid plept�i_--- -----�__.--------Capacity --- / Dispos Field: Distance from nearest well__vU_ - istance from founds io � ___�istance to nearest lot lin Number of lines._________ _ Length of each lin ___ _______ i '�� 9 � D ,�.Width of french-- Aj of filter materi bf Depth of filter material___-_-_1 ----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-------------------- material_____--_____.________-_______-_-___-_. ❑ Size: Diameter--------------------------------------Depth----------------------- ---------------------------Liquid Capacity--------------------------•-gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building_________________________________________ ❑ Distance to nearest lot line---------------------------------------------------------------------------------------------------------------------------------------------- Kmo filing r:d/or repai i g.�d s,' e ---------------------------------------------------------------------------------------•------•------------------------•------•-------------- -•--.. ---------•--------------------------------------------------------------------•---------------------------------------------------- ---------------------- ---------------------------------------------------------------•-------------------------------------------------------------------------------------------------------------------------•--------- ------------------------ 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)--- t ------------------------------------------------------------------------------(Owner and/or Contractor) gY ------------------------------------------------------------------------------------(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-- --- --- --------------------------------- --- ---------I--------------------------------- DATE_ REVIEWEDBY-------------------------- --------------------------- --- ------- ------------------------------------ DATE- ----- - ----- BUILDING PERMIT ISSUED--------------------------------------------------------------•--------------------------------------- DATE A.l;erations end/or reco imendations-_-- --;----- - -- - '` - ---- ----------- - J ----------------- -----------. I- - Ph- r l --_��------rte5------------------------------------------------------------------------------------------- l - e-'t- ` . --------------------------------------------------------- - . ---- ----------- _ -- , S - A6- �V FINAL INSPECTION BY------------- ---- _ ------------------------------ Dale----------j-- 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 8-51 Revised W-2100