11083 - Laserfiche WebLink

Home Browse Search

f PPLICATION FOR SANITATION PERMIT Permit No. ^�I .0- (Complete in Duplicate) - �jDate Issued_ - Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein des ribed. This application is made in compliance with County Ordinance No. 549. Of JOB ADDRESS AND, LOCATION__!: �"' = • -' f _7-- --------------------------- Owner's Name --- _ �. ----- --------------- -- - -- --------•-----•• -- ------- ------------------------------------------------ Phone -----------•-- -• --•---------- Address ------------- 3 - Contractor's Name :.` = = = x�"-------------------------------------------------------------------------------------•----------------------- Phone ----------------------------------- Installation will serve: Residence Apartment House r Commercial ElTrailer Court [-]Motel El Other E]Number of living units: _ �____ Number of bedrooms ✓___-- Number of baths _X___ Lot size --0'-- - --------------------------- Water Supply: Public system ❑ Community system ❑ Privafea Depth to Water Table4D_ ft. Character of soil to a depth of 3 feet: Sand F] Gravel E] Sandy Loam �0 Clay Loam ❑ Clay ❑ Adobe [❑ Hardpan ❑ Previous Application Made: Yes ❑ No (K New Construction: Yes No ❑ FHA/VA: Yes j j No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Sep Tank: compartments nearest stance fromfoundation ---- /_�_________ Materia#:-�No. of ------Size_Y.4-4; �`-n ------Liquid depth_*C--------------------Capacify./e------- Disposal Field: Distance from nearest weli_4+�r____._Distance from found io _y_�_______.Distance to nearest lot line --- �r?_--____-__. Number of lines�- ength of each line - Seepage of- _ L -------------- Type of filter materi _ Depth of filter materiaLl�_____-_____._Tofal length_-�"�-- -f ----------- 'Length Pit: Distance to nearest well ---------------------- Distance from foundation ---------------- .__.Distance to nearest lot line __.__-________.__ ❑ Number of pits---------------------- Lining material ----------------------- Size: Diamefer------------------------ Depth-_-.----------------------------- Cesspool: --------------------_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 ------------------------------------------ 1-71 Distance to nearest lot line - Remo eling and//r-- iri"g {decrib - .;�-- ------------------------•------------------------ - - -- --- -- -- .__ •--- -------------------- - -------------------•--•-------------•------------------------------------------------------------------------------------•---------------------------•---------------------------------- 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 reguiations.of the San Joaquin Local Health District. (Signed) -------------------------------------------------------------- -------------------------------------------------------------------------------------------------(Owner and/or Contractor) By: ------------------------------------ -----------------------------------------------------------------------------------------------(Title)-------------------------------.--:_---------------�:._�� (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., cart'be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_ , 4----------------------------------------------------------- DATE__- -- - ------------------------ REVIEWED BY------------------------------------------------------------------------------------------ ----- DATE ------------------- BUILDINGPERMIT ISSUED ------------- -------------------------------------------------- -------------------------------------- DATE -- --------------------------------- Alterations and/or recommendations: ----------------------------------------------- -------------------------------------------------------•--- -------------------------------------------------------------------•----------•-------------------------------- ----------------------------------------------------------------------------- FINAL INSPECTION BY:_,14_ ' { �' Date f b `r 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 1.57 EP.tO.