4073 - Laserfiche WebLink

Home Browse Search

� � 1 / APPLICATiON FOR SANITATION PERMIT Permit { (Complete in Duplicate) Data Issued --- Application _-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. JOB ADDRESS AND LOCATION ;; -L-� ____8 "N-'--....F-- -------- ----------------------------- ---- -- -------- Phone-------------------------------------------- Owners Name______ __________ _ � # Address----------•------------------------------------------•---------------- ------------------------------- Contractors Name-------- ------ Phone-_--------------------- ----- 1 a Installation will serve: Residence F1 Apartment House ❑ Commercial Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms -------- Number of baths -------- Lot size _____`='__._____ ._ -----'----------------------------- Water Supply: Public system ommunity system El Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ .Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank ar cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation__.___________.._.Material_________---_____.___________.___.______._____. ❑ --Liquid depth----------- ---_--------Capacity No. of compartments ------ ----Size-------------------- -------- Disposal Field: Distance from nearest well... ...........:.Distance from foundation--------------------Distance to nearest lot line---------------- Number of lines-----------------------------------Length of each line------------------------------Width of trench----------------------------------- ❑ Type of filter material-------------------------Depth of filter material-----------------------Total length------------------------------------------ Seepage Pit: Distance to nearest well----------------------Distance from foundation_______.____.._____.Distance to nearest lot line--_-_...______.__ ❑ Number of pits----------------------Lining .material--- --=----------------Size: Diameter.- Depth sI Cesspool: Distance from nearest well_____1'3-C'_____Distance from foundation___--{O-_-----_Lining material----------r --------- „Size: Diameter-------- De th---=-----------�--1-------------------------------Liquid Capacity-------X50-----------gals. Privy: Distance from nearest well__________________ -____.__---________Distance from nearest building------------------------______._____-_ ❑ Distance to nearest lot line------------- ----------- -- Remodeling and/or repairing (describe):-------------------------------- �r�t-------------VX.A- ---------` ----- -------------------- h -----•------ --------------_----------- ------- ------------------------------------------------ -- ------------------ o ----•----------- i I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County 4 ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. I Contractor) ` s { ______-(Owner and/or 1 (Signed)------------ -- - ---------•-By: ---------�-- --------- -------- ------------ ---- ------ ------ ---------------- n size of loft ------ ---------------------------(Title}- --- ------------ € [Plot plan, showi gi '# , location of st m in relation to well b ildings, etc., can be placed on reverse side]. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------- "`--------- ----------------- DATE------------ f � --------------- -----------�DATE REVIEWED BY--------------------------------------- .BUILDING PERMIT ISSUED-------------------`-'----- -------- DATE------------------------------------------------------------- Alterations and/or recommendations:-------------------- ---------------------•-- --------------------------•------------- . . ----------------•------------------------- -------------------------------------------------------------------------------------------------------- ------------------------- --- ------- --------------------------- 7 ------------------- ----------- FINAL INSPECTION BY:----------------_'.r--- ---------- Date. ! .- SAN JOAQUIN LOCAL HEALTH DISTRICT 130'South American Street 30D 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