3017 - Laserfiche WebLink

Home Browse Search

�PPLICATION FOR SANITATION PERMl " Permit No�_� _ -- � (Complete in Duplicate) Date Issued A lication is hereb made the San Joa u•:n Local Health District for permit t pp y q p o construct and install the work herein described. This application is made in compliance with County Ordinance No. 544. r JOB ADDRESS AND L - �.� ----- ------------------------------`----------- Owner's Name-- ---- - ------------ --- ---------------- ----------------------------- Phone- Address------------------------ neAddress------------------------ -- ---- -- --"-------- F C�4 Contractor's Name-------------- ------- -------------------------------------------------- Ins -----_- --_--- Installation will serve: Residence Apartment House ❑ Commercial ] Trailer Court j] Motel ❑ Other ❑ Number of living units: __ ___ Number of bedrooms .�9_ Number of baths._/__ Lot size ------ gr -ly,_/ ----------------- J Water Supply: Public system0 Community system ❑ PrivateX Depth to Water Table--e-Sft. Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan❑ Previous Application Made: Yes ❑ No New Construction: Yes ❑ No ril"-, TYPE OF INSTALLATION AND SPECIFICATIONS: 11 i (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ---Distance from foundation------ /--. Septic Tank: Distance from nearest- well__ __ �_*____ Material -- ----------------- --------------- �+cl5�i No. of compartments--------------------------Size---------------------------•-•-Liquid depth--------------------------Capacity----------------------- Disposal Fiel Distance from nearest well__---------------_Distance from foundation--------------------Distance to nearest lot line_________________ ❑ Number of lines-------------------------""--- Length of each line------------------------------ of trench--------------------- Type of filter material-------------------------Depth of filter material----------------------Total length---------------------------------------- •- .t ! / -- Seepage Pit: Distance to nearest we I___I_- -------Distance fr m fou ation______�_ to nearest lot line___________ a _______.Dist ______ Number of pits---------- --------Lining materia � Size. Diameter-- .4 �nce -- 41 Cesspool: Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------------------------------- El __._ ______-_______________________-❑ Size: Diameter----------------------i--------------Depth--------------------•--•----------------------------Liquid Capacity----------------------------gals, Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ F1 Distance to nearest lot line Remodeling and/or repairing (describe):-------------- � ��'�_-_ •- --------- �------------•------------------------•---------------------- ----------------------------•---------------------------------------------------- -------------•------------------------------------------------------------------------ �. ------------------------------------------------------------------------------•-----•----------------------•--------------------------------•--•----------------•-•------------•--------•----------------------------------- hereby certify that I have prepared this application and that the work will be done ins accordance with San Joaquin County ordinances, State s, and riAles and regulations of the San Joaquin Local Health District. (Signed)------- 'Y - - --- -------- ------------------------------------------------------------------------------------------------- ------(Owner and/or Contractor) $y:----- -------- .� - ------------------------------------------------------------------ Title (Plot plan, showing ze of lot, lacatian of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------------------------------- ------ -------------------------------------- DATE------_--- � _ REVIEWEDBY--------------------------------------------------------------- ------------------------------------------- DATE ' Z `S ------- BUILDING PERMIT ISSUED-------------------------------------------------------------•---------------------------------------- DATE Alterationsand/or recommendations:--------------------------------------------------------------------------------------------------•------------------------------------ ----------------------- ---------------------------------------------•-------------------------------------------------------------------------------------------------------------------------------•--------------------•-------------------------- ------------•-----------------------------------------•----------- ---------------.-------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------•------------------------ ---------------------------------------------------•--------------------------------------------------------------------------- -- FINAL INSPECTION BY .--=--` ' �`� � "-------------- Date------ y 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-4-2M 8-51 Revised W-2100