4150 - Laserfiche WebLink

Home Browse Search

77 ee APPLICATION FOR SANITATION PERMIT Permit No.(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. de- JOB ADDRESS AND LOCATION. »� --- — -- -- 9 ------------------------ ---------------------------------------- Owner's Name........................................... hQ8------------------------------------------ Phone.................................... Address....................................................... •-•-- -- . . - PhoneContractors Name................ •• ------- Installation will serve: Residence X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms ---J---- Number of baths -----)_ Lot size ........70....__._-%l'...Zt y.................... Water Supply: Public system '❑ Community system it PrivateX Depth to Water Table .M ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay❑ Adobe,1' Hardpan ❑ Previous Application Made: Yes ❑ No� 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-----------------Distance from foundation--------------------Material:__-__-___-_________-________--.-______:___-- exl�-Vl4i� . No. of compartments-------------------- ---Size------------------------•---...Liquid depth--------------------------Capacity----------------------- Disposal Field: Distance from nearest well------6Q------Distance from founda 'on__-____.&_____-Distance to nearest lot line-----i!�..__....v ( J Number of lines_____________�_�__-_-�_-Length of each (ine _ 9--1C ".Width of trench------------.40 v�' Type of filter material--------�_l__}0_cG Depth of filter material.-------t_$.........Total length.........11?o. .....................� 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/A repairing (describe):---------------------------------------------------------------------- ----- --------••------•-••---•---•----•-•-•-•---------•-••--•----••---•••----••-•----------------•--••---------------------------••-----••••--•--------------------------------------------------------------------------- ----- --------------------- ------------------------•-----------P-----------------Pp--------------------------------------------------------------•---------------------------------------------------------------------- I here ertif that I ha re ared this application and that the work will be done in accordance with San Joa uin Count ordinances S e ws, and r-- s and r gulations 't San Joaquin Local Health District. (Signed)-• ,•---------------=- ---------- --------------------------------------------------------------------------------------------------------------------(Owner and/or Contractor) r --- ------------------------------------------------------------------------------------------------------------------------------(Title)---------------------------------------------------------------- (Plot pl n, howing 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---------------------------------------------- ---------- U � ----------------------------------------- DATE-_--------- - -� BUILDING PERMIT ISSUED...................................................................................................... DATE..............Z....... -------------------------------- Alterationsand/or recommendations:.----------------- <----•---•----------------•-----------•---------- -•----•-••------- ----.......................................................... -----••---------------•---------•---------------------------------------------------•--•--------•-------•---------------•-•--•--.....----------•-•-----•----------•-----•----•--•--------------••---•---••••---•... ------------•-•----------------------------------------------------------- --------------------- -•----------•--•--------•--•-------------------------•-----------------------••----------------------•------............ .. ---•-- -------------------------------------------------...............•-----------------•-•--- ..................... ................... -----------------------•-•------ ------------------------------------- ---------- ---------•--------•--•--------------------- .......................... •------------------------------------------------------------ •----•-------------------••------- 1//Z.FINAL INSPECTION BY:-----------------------V�Z. Aim--------- Date--------- Jr. --------------------------------_------------------ 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 10-52 Revised W-2100