3410 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. -3: ------ (Complete-in v____.(Complete_in.Duplicate) Date issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and instal{ the work herein described. This application is made in,compliance with County Ordinance No. S49. JOB ADDRESS AND' LOCATION = - c'T Y � � ---- --- - �----�� Owner's Name-- ------------\/)/--------- -------r-----•-'--- -------- Phone------------------------------------ Address___ ------------------------- -------------- Contractor's Name - ---J `---------------------------------------------------------- ----- ------ Phone------------------------- Installaflon will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel 0 Other ❑ Number of living units: ___ Number of bedrooms _5�_ Number of baths ___""Lot size --------V/ / / �^ ------------------------------------ Water Supply: Public system E] Community system ❑ [� ee private- pth to Water Table �f_© ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [ lay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes [J No [ New Construction: Yes [R—'IVo ❑ 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__�-_1h_Distance fr m foundation_ __ _ p / 1_ -Material ------------------- [ No. of compartments________'— Sizel© ! X 3_}tr; uid de th_��__ y /I -- foundation q P ��--~capacity----- �--`-""-------------- Disposal Field: Distance from nearest well---!Y_y_� Distance from foundation______f_��_-_.Distance to nearest lot li e______ R Number of lines----------I- ----------------- T rr_Length of each line_____/____-6_____ Width of trench____�_� ---- ----------- Yp IC _ - Z__ _Depth of filter material T1'- Total length_____-___f__�----------------------------- Seepage _____ _ ________ __ Type of filter materia � _ 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------------------------------------ ElSize: Diameter-------------------------------------Depth--------------- ------------------------------------Liquid Capacity----------------------------gals. =. . , _ a. ,.. 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 fhaf 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) By:---_------------------------------------------------------------------------------------------------------------------------------- (Title)-------- - - - --------------------------- li (Plot plan, showing size of lot, location of system in relafion to wells, buildings, efc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED ---------- 7-------------------- ------------ --------- - DATE �� ---- ----- REVIEWEDBY----------------------------------------- ------------------------- ----- ------------------------------- -------- DATE---- -- - ----- ------------------------------------- ' BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE Alterations and/or recommendations------------------------------------------------------------------------------------------------- r ------------------------------------------------------------------ ----- ----------------------------------•---------------------------- - ---------------- f r = XPY r t FINAL INSPECTION BY:. ------=-= -------------- Date---------- + r SAN JOAQUIN LOCAL HEALTH DISTRICT f 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