6923 - Laserfiche WebLink

Home Browse Search

\r APPLICATION FOR SANITATION PERMIT Permit No. ___ _. _.• (Complete in Duplicate) //ff . Date Issued Applica-lion is hereby made to the San Joaquin Local Health District for a permit to onstruct and ins t a war fC herein described. This application is made in compliance ith County Ordinance No. 549, Val . W, JOB ADDRESStD LOC . IO -- ��------------------- ----• ---------�� ------------- a . �Owner's Name .a --"- ...... Phone, Address-----------------1--� t-------------------------- -----------------------------••----------•---•--- -----------------------•-- --- -R-------- -••----- ._- Phone ..._Contractor's Name - �y - Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court M ❑ Other s. ��.rc� , Number of living units: _____._ umber of bedrooms -------- Number of baths !�___-- Lot size ------------ �_ .._.�__r,W- Water Supply: Public system [Community system ❑ Private ❑ Depth to Water Table /7./Qft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 2'--Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes 2--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 wellti�..__Distancefrom foundation-/0 --- _ �/ ,�- r� Na. of compartments.._ _.._._.._ _.Liquid depth..a___ ______________Capacity_� '�� ----------- --- Disposal Field: Distance from nearest well ___ Distance from foundation--- ...----Distance to nearest lot Number of lines------- --------------------------Length of each line---4Q_-'.------------.Width of --._____._ Type of filter materiaL__.�,;�2,-'_Pll,__Depth of filter material_-_-.--t&'------Total length----- --`-------_-_------------- Seepag Pit: Distance to nearest well-A-011'Le------Distance from foundation-------------------.Distance to nearest lot line----------------- Number of pits----`----------------Lining mate rial_8&Z,�45--------Size: Diameter___!"0"/--------Depth....�<.S--------------- - Cesspool: Distance from nearest well-----------------Distance from foundation---_------......... Lining material-----___---.--_-_._.---.------_-.- b ❑ Size: Diameter- - -------- -------------------------Depth----=-----------------------------------------------Liquid Capacity-.--------------------------gals. C Privy: Distance from nearest well__"--------------------------- ___------------------Distance from nearest building--------------------------------.-------_.0 ❑ Distance to nearest lot line---------------------------- 4 Remodeling and/or repairing (describe):_ _a __ ------------------------------------------------------------ = x -- ---------------•----"----"--------------------------------. ---.-----.-••----------------------------------------------------•-----..--------------------------I------•---------••-----------------------------------•----------------------•---------------------------------•----------- ------------------••---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------C ------------------------------------------- -----------------------------------------------------------I--------------------------------------------------------------------------------------=-----------------------------F I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State a s, and rules and re ulations of the San Joaquin Local Health District. [signed} r-- - "'"`'-- -- - --- r ` Contractor) BY: - - ---------- --- - ----------(Title) --------------------------- By: (Plot plan, showing size of lot, location of system in relation to ells, building 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: --- - ---------------------------------------------------------------------------•--------------------- "- ---. r --------------- ---- - -- ------------- --------- ---------------•------------------------ -------------------- ------------ -------------------------------------------------------------------------------------------------------- ---------------------------- ------------------------------------------------------------------------- FINALINSPECTION BY:---------t.f-�-)-'._�-----------------------•------- Date----- . -- - ----------------------------------•-------------------" SAN JOAQUIN LOCAL HEALTH DISTRICT 130 Soufh American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California e5 7-2M iasaae a-rwaoo