6976 - Laserfiche WebLink

Home Browse Search

r i ✓ J APPLICATION FOR SANITATION PERMIT Permit No. ..... `�. .4.. t (Complete in Duplicate) k Date Issued -----44-1_--__-- Applica+ion 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____ �-------- Owner's Name C - ------ Phone--------------------------------- Address------ '......... ..... ---------------------- ----- -----.-_--_---------------------------------.-_---------------------------------------------- Contractor's Name--- ---------•------------------------------------------------------------- --------- Phone/+!i Installation will serve: Residence rtment House❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ � y Number of living units: I... Number of bedrooms _2— Number of baths______ Lot size _�o__/�__�_�__�_____________________________ Water Supply: Public system 4--6ommunity system ❑ Private ❑ Depth to Water Table J-b ft. ' Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ Previous Application Made: Yes ❑ No 2�_New Construction: Yes ❑ No L 'r TYPE OF INSTALLATION AND SPECIFICATIONS: - 1 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r Se is,Tan . f Distance from nearest well_________________Distance from foundation__.__________.___..Material------------------------------------------------- No. of compartments---------- ---------------Size------------------------•---:___Liquid depth--------------------------Capacity----------------------- isp sal.It Fiel Distance from nearest well.............. ..Distance from foundation-----------.--------Distance to nearest lot line------------..... r 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 Distance from foundation----J?'_r.--Distance to nearest lot line____ 1-�--� Number of pits-----I_-_____-___-_--Lining material__.t Yve�,____Size: Diameter---33._'-_.......Depfn...4_�------------- ---- Cesspool: Distance from nearest well-----------------Distance from foundation_____..-------------Lining material___.----------------____.___ 1771 Size: Diameter--- ----------------------De th_-------- --- --------------------------------------Liquid Capacity gals. Privy: Distance from nearest well.-------- _-------------------------------------Distance from nearest building____._--____--_________________._.__.__ .•., ❑ Distance to nearest lot line-------------------------- --I--------- ----r- --------------------------------------------------------------------------------------------- Remodelingand/or repair:ng (describe):---------------------------------------------------------------------------------------------------------------_-_--_--------_-- ----------_----.A -----------------------------------------------•-•----------------------•------------------------------------------•-------------•----------•--•--•--------------------------------•----•--------------------------------- ----------------------------------•---------------------- •------•---------•-•-----------------•---.-------------------------------------•--------------------.-.-------------------------------•-•-----•--••------- ------------------------------------ ----------------•---------------•-----------------------•-----------------------------------------------------------•------------------•-•----------------------------------------------- I hereby certify that i have prepared this application and that +he work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. _______________ __ ___ ___Owner and/or Contractor Signed � ---------- ---- --- -- ( / 1 $ Title --------------- ----- Y•--- ------------------ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.--- - --- DATE----- -- --------------------------- - --------------- REVIEWED BY ---- ------------- ---------------------------------------- DATE--------- ----------------------------------- BUILDING PERMIT ISSUED DATE 1iy------------ - Alterations and/or recommendations:--------- -------- ----------- ----------------------__•------------------- --------------------------------------- ....V�•------....--..__---- - ------ ------- - --r----- -- - -------- ------------------------ -------------------------------------- - ---------- -------------------------------------------------------------------------- -------- ------- --- ------------- FINALINSPECTION BY:---- -------------------------------- 1 yr----------------------------------------------------------- SAN -SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 614 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E5-9-2M 145446 ATWUQU 12-5a