2831 - Laserfiche WebLink

Home Browse Search

�-�- 2- Permit- APPLICATION FOR SANITATION 3 i p ON Pi=RMIT No. _� _____________ (Complete in Duplicate) y Date Issued 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. f Q � . JOB ADDRESS AND LOCATION-------__ __ __________________________r__ oN� �T Owner's Name_----------•------- ./ = .- ----- ------------------ Phone -------------------------------- Address--------•--------yllx_ � � W , Contractor's Name '--------------------------- Phone_1_'"L__�O 7 ------------ Installation will serve: Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: J__- Number of bedrooms _��-_---- Number of baths __1____ Lot size ------------ Water Supply: Public system ® Community system .0 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 ❑ Na -. New Construction: Yes ❑ NonQ ,K TYPE OF INSTALLATION AND SPECIFICATIONS: � (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r Sis Tank Distance from nearest well_________________Distance from foundation--------------------Material-------------------------------_______--________---- No. of compartments------------------------ Size---------------------------- ---Liquid depth--------------------------Capacity-•------------------ - Di osal 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_AV fes-____Distance from foundation---!__ ---------Distance to nearest lot-line-__- _________ ® Number of pits--------._1----------Lining material � R ize: Diameter--------'JJ---------Depth_ lQ= ------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material----______ --- Size: Diameter--------•-----------------------------Depth----------------------------------------------------Liquid Capacity-------------------------_gals. Privy: Distance from nearest well-------------------------------------------------- from nearest building--- --______--______ -------------------------------- ------- El Distance to nearest lot line - ----------------------------------------------------- Remodeling and/or repairing {describe):------------------------------------------------------------------------------------------- ------•-----------------------------•----------------------•------------------------------------------•---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 District. l -- SS' �u (�1or Contractor) By: +F-'-- -- --- -- ------------------- ---------------- ---------- Title- -� �� N --- ---------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- -------------�' -------------------------------------------------------- DATE----------- '== - ------------ i REVIEWED BY y - ------- --------------- ---------------- - DATE-----� -` ---'---------- - - - - ----------------------------- BUILDING PERMIT ISSUED-------------------------------------- ----------- -------------------------------------------------- DATE Alterations and/or recommendations----------------------------------- ----------------------------------------------------------------------------------------------------------------- . . ------------------------------------------------ ------------------------ ---- { - ---------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------ -------------------- ------------------------ ------------------------------------------ -------------- FINAL INSPECTION BY-------- -- -----=(�__ / -------------- Da+e------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wes+ Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES--9-21v1 B-51 Revised W-2100