6632 - Laserfiche WebLink

Home Browse Search

y `\ APPLICATION FOR SANITATION PERMIT Permit No. ._.. .G. z (Complete in Duplicate) Date Issued Applica+ion 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. t/'� �" . . .-�_ JOB ADDRESS AND OCATION------- ----I- ------ ----------------------------------•------------------------------------- x, Owner's Name-- 7 ........... � --------------- ---------------------------------------- Phone.................................... Address--------- ------ q / ... Contractor's Name ;2- --------------------------------------------------------------------- Phone Installation will serve: Residence O` Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __,___ Number of bedrooms Number of baths ... Lot size ......7 __A /CrM).__•- --------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table d ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ek Hardpan ❑ Previous Application Made: Yes ❑ No E& New Construction: Yes ❑ No 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-_l/ Distance from foundation_a`Zd------------.Material----. ----_. .r No. of compartments-------.2..-------------Size__,.1�..�... -..Liquid depth------ Capacity_. Disposal Field: Distance from nearest well-_ istance from foundation_.___4a___------Distance to nearest lot line..-. �._.... tK Number of lines........../------ Q Length of each line..........4:J_---__..��___.Width of trench_--sem--`/n_ ___ _ Type of filter material____- Depth of filter material_.-___- ____Total length__ 1,:::"'........................ a r_Seepage Pit: Distance to nearest well____A�__Distance from foundation-----4�.�.__....Distafnce to nearest lot line_______ _ W Number.of pits---------- -----------Lining material.UC__-- ,4- rse: Diameter.__5�3__ ---------Depth.----- ------------ Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining material•___________._._____________--__._---. �} ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------Liquid Capacity---------__----------------gals. Y� Privy: Distance from nearest well-------------------------------------------------Distance from nearest building ❑ Distance to nearest lot line-------------------------------------•-----•-----------------------•-------------•--------•-------------•----------------- ----------------- Remodeling and/or repairing (describe):--------------------------------------------------------------------------------------------------------------------------------------------------------- •-••••-•---•-••--•••-•-•---•••-•-------------------•---•----------•----•--••--•-•-•------------------------------•-•••-•••--•••-••-----•--•---•--•---•-•-•-----•--•---............................-------------------------- -------------------------------------------------------•-------------------•---------------------------------------------------------------------------------------•-------------------•------------------------------------ -----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------••-••--••--- ------- 1 hereby certify tba#.I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State ws, a d rules and iregulations of the San Joaquin Local Health District. (Signed)... f l:,l G=- ' - ./ ='-__..:'.... ' (Own and/or Contractor) B . ------.. (Plot plan, s wmg 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--------�-------•--------- REVIEWED BY----------------------_-------- - DATE....... -- ---- ------------�- •----------------------- BUILDING PERMIT ISSUED............ ------ ---- - DATE------------- ................................ Alterations and/or recommendations:--------------------- ----- 3- -- ------•------------•............................. ------------------------------------------::---------- -----------\- ------ ------------------------------------------- FINAL INSPECTION BY:--------C..... ............................................. Date.... . --- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Strut Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised W-2100