4060 - Laserfiche WebLink

Home Browse Search

, 4PPLCATION FOR SANITATION PERMIT jermit No. -- --------- -- D ,.� 6I ----------- (Complete in Duplicate) u t e-� �` "Date Issued �� Application is hereby made to the San Joaquin Local Health District for a permit to construct and irl i l the rk rbig described. This application is made in compliance with V ryFy Qrdinan_ $ ' r-zm- m v `T 1, N JOB ADDRESS AND LOCATIONS -r,,.,,t,,,l Owner's Name---- r ------ . .. ------- - ------ -- -- Phone-------�27 7 Address------ .. 114VContractor's Name _ -_ / _______________ Phone_- -'4'72-_x_ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other El Number of living units: __!____ Number of bedrooms __" Number of baths J---- Lot size,_-__ Water Supply: Public system ❑ Communitysystem ` y ❑ Private �epth to Water Table l:k ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe❑ Har dpaq [] Previous Application Made: Yes ❑ No 5— New Construction: Yes 4—Ho ❑ 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----!_T--___Distance rfrom foundation_____1-----/-2--/_-_.___.Material__ ET. f t....... 1- No. of compartments----------�-------------Size---&-7 -----Liquid depth------4/.- ---------.Capacity--- v —4 - --- -------- Disposal Field: Distance from nearest well._- 1 --_Distance from foundation___-_AS y. r • • �.____.Distance to nearest lot Number of linesf -- -- -__----Length of each line-__--- --s.__---------Width of trench-_--- moi. ___"'_---- -- s 1 Type or filter material_--"--------�_____Depth of filter maferial__--_�__ .''_-_Total length------- �D1------------ ------------ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot Zine__.______--___.._ ❑ Number of pits i-------------------Lining material-----------------------Size: Diameter-------------_------Depth...------ ------- ---- Cesspool: Distance from nearest well________ __ Distance from foundation--------------------Lining material___--.__-______________-._____.____-� ❑... Size: Diameter -----Depth-----------—•-•--------------------- ----Liquid Capacity- galsi ( Privy: Distance from nearest well-------------------------------------------------Distance from nearesf building-- Distance to nearest lot line.-___ ❑ - ---------------------------------- Remodeling and/or repairing (describe)__________________-____-_______- ' i --------------------------- --------------------------------- ------------- ------------------------------------------ ------- --------- ----------------------------------------------------------------------------•-------------------------•---------------------------- ----------------------------•--------------•--------------------------------- i 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 istricf. [Signed)----- . t � .- - - -------- -- Contract By:------- ----------------- - -------- - --------{Title)-----=---= or) (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_<,_�_._-}-------- __ ____________________ DATE ------•-• ----- REVIEWED BY -------------- DATE ��-�- I BUILDING PERMIT ISSUED-----•----------------------- • - -------•------- ' DATE_.- -��_ Alterations and/or recommendations:-----------_--------- -------------- __ , ----•--------------------•-- --------•-------------------- ----------------------------------------- --------------- ----- ----------------------------------------- - FINAL 'INSPECTIO Dat ---- S i --------------- ----------------------------------------------- --------- ---------- SAN JOAQUIN LOCAL HEALTH RICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 Nor+h "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M f0-52 Revised W-2100