7376 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. ---� --- 7 .- p (Complete in Duplicate) PDate Issued --- Applicai-ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. i This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION-------------------- } Owners Name tti�- 'i ` + Phone ----------------------------------------- ..... - --•------ ---------•- w Address--------------------.1 -vo---- A----- E ----------------------------------------------------------------------------------------------------------------- ----------- Contractor's Name------------------ '1------------------------------------------------------------------------------------------------------- Phone----------------------------------- Installation will serve: Residence I Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: I----- Number of bedrooms `2w- Number of baths --.--_-- Lot size ------------------------.- Water Supply: Public system V Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam E] Clay Loam E] Clay [j Adobe Hardpan ❑. i Previous Application Made: Yes E] No New Construction: Yes No ❑ I 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-----.--------------.---------•••----__---------. t ❑ No. of compartments------------ ----- -----Size------••---------------------- Liquid depth--------------------------Capacity----------------------- '�' 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- ------------------- ------------- 4 Cesspool: Distance from nearest well--- .--.--Distance from foundation-- material- - .- Cr _ 4 , Size: Diameter-- - - - - - ----------Depth----- .------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building___--._----------_---------------_------. ❑ Distance to nearest lot line-------=------ --=----------------------------------------------- -- -------------------------•---------------- Remodeling and/or repairing (describe)---------- ---------------------------- ---------•-----.....-•---------•---------------------------------------- ------------------------------------------------------------------------------•----------------------- ------------------•--....-------------------------------------------------------------------- ------------------------------------------------ ---------------•---••---------------------------------------•--------------------------------------------------------------------------------------------------------------- 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 p the San Joa uin Local Health District. (Signed)------V1_ ----- n� --- = - Owner and/or Contractor) ------ -------------- --------------------------------------------Title -`---------------------- (Plot plan, showing siz `of'lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY �u APPLICATION ACCEPTED BY-------------------------------------------------------------------------------------------------- DATE-----------------•------- REVIEWEDBY-------------------------------- ---------- =---- ------------------------------------------------------------------ •--- DATE-- •-----------------------------------•-------•------------ BUILDING PERMIT ISSUED-----'-----------------• ------------------';-------------------- ----------------------------------- DATE----------------4-------------------------------------------- Alterations and/or recommendations:_-: - ------- ---------- - ----___-----------•--•---------:--•---•-------------a-------------------------------------••-•----•-- ------------------------------------ ----------------------------------------- -------------- -- ---- I-•-------•- -------------- ------------------------------------------------------------- •---- --- ----------------------------------------------------------------------- --------------------------- ----------------- ----------------------------------------------------••------------------------------------------ _/ FINAL INSPECTION BY------- ----------- -" Date - 1 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 145-6 ATWOMD 12-54