6034 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. ___ O3- __ )[`�► (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 Ordinanc o. 549. JOBADDRESS AND LOCATION---. . ..--(//f ---------•--- --- ----------------------- ---------------------------------------------------•--..----------------------------- Owner's Name-/�I � ---._... a ------------------- ------------------------------------------------------ Phone.................................... Address -� -`-k - - - �L_. - ---�. •- - /.. Contractor's Name_--- i$.'tA---- ------ ------- ------- --- Phone "tr '". Y�.{.e Installation will serve: Residence 4--.C'partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .--/--- Number of bedrooms __2s Number of baths __/_.__ Lot size __:__ _ _d-_ ......,X_.1_4`0............. Water Supply: Public system ❑ Community system ❑ Private 4_Depth to Water Table Yrft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ Previous Application Made: Yes 0 No [A_ flew Construction: Yes A-4+0-❑ 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__! _____Distance from foundation------I....___.Material---- _--___. �....► No. of compartments-------___L--------Size---4 r- _Jr___„X--- Liquid depth_44_J'__.___-_:___Capacity___ `_________ Disposal Field: Distance from nearest well---5--a----Distance from foundation.....,j+_D-_'..Distance to nearest lot line____jt0___'__ Number of lines-------_____l___-__y______- Length of each line---------�_X-_'_��___-Width of trench__."��'____________________ Type of filter material____1__ _ Depth of filter material_____-)__e--_______Total length......: _J____________________________ Seepage Pit: Distance to nearest well___:�_61_______Distance frromtfoundation____., Q______.Distance to nearest lot line____ _______ [ Number of pits-------/-------------Lining material__.131AAA----.Size: Diameter_.?.?----_-------Depth--�-,I��--------- 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__________--_-_-______________________-_- �J ❑ Distance to nearest lot line---------------------------------------------------------------------------------------•----------------•------------------------------------ Remodelingand/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, S 41aw", and rules and regulations f the San Joaquin Local Health District. (Signed) --- / '�......................... Contractor) ZV 10 By:............ ---• -- ------ ....-.............................................(rtle)_- ----- ------ - --- ------ ----- -------- (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 APPLICATIONACCEPTED - -- - - --------- ----------------------------------------------- DATE--------�---- ---•----------------------- REVIEWED BY - ----- - ------•- -- DATE BUILDINGPERMIT ISSUED-- -- •-------•---- -- ........................................... DATE---------------- -- -------------------•------•- Alterations and/or recommendations------------- ------ - -•-------------••-- •-.-•--•---•- ---•-•---•----••-••-••••-- �.��---------- .................................................... -------------•------- -------- . . ........................ - ----------------------------------------------------------------- .............. ......................................................_-------------------------------____------------------------------------------------ FINAL INSPECTION BY:_--.... •. -.------------------ -•------•----•---- 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 ES-9-2M ' Revised W-2100