6580 - Laserfiche WebLink

Home Browse Search

UAPPLICATION FOR SANITATION PERMIT Permit No. ____�`��_ (Complete in Duplicate) �- Date Issued __._-/--.�'b__ ?Apjplica-`ion is hereby tmade 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 o- 54 t J 10— JOB ADDRESS AND LOCATION__ 31!re-( - --__ 1---•- Phone--------Owner's Name---- � E, -----------• --------------------- --- o --------`--------------•---------• Address--,/S/_- =� - ---- ---•---- - Contractor's Name__._ _ -� _____• Phone' 1 ',. -•_------ -------•----- Installation will serve: Residence artment House ❑ Commercial ❑ Trailer Court ❑ Mofel ❑ Other ❑ Number of living units: _J-__ Number of bedrooms I__- Number of baths __/__ Lot size _-__---- -- d ,�,t�- ----------------- Water Supply: Public system �ommunity system ❑ Private ❑ Depth to Water Table Uft. Character of soil to a depth of 3 feet:{ Sand ❑ Gravei ❑ Sandy Loam ❑ Clay Loam [] Clay ❑ Adobe 6—H rdpan ❑ Previous Application Made: Yes ❑ No 9—New Construction: Yes ❑ No R�— TYPE OF INSTALLATION AND SPECIFICATIONS: _ {No septic tank or cesspool permitted if public sewer is available within 200 fee+.) Septic ank: Distance from nearest weliO. .....Distance from foundation----/_�_.�----MateriP!_____. .____________----------------------- v No. of compartments...---2----------------Size__�4----X_L/-Q-,---Liquid depth------�'t' - .l---------Capacity�'�_Q -------- i Disposal Field Distance from nearest wEll- -Distance from foundation.-/_.o;�--!'- Distance to nearest lot liner Number of lines-__ -------Z._.. ..�1-i------Length of each line--------&_0--------------Width of trench---.��-------------------_ Type of filter material___- .-- ------------- of filter material-__.-,0 --- -Total length---- C' ' Seepage Pit: Distance to nearest well______________________Distance from foundation----------------.__.Distance to nearest lot line_.______-_-______ ❑ Number of pits----------------------Lining material----------- ----------.Size: Diameter----------------------.Depth----------------------------- -- �, 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------------------------------------------ El Distance to nearest lot line__________________. i. Remodeling and/or repairing (describe):-------------------------------------------------------------------------------------------------- -------------- -------------------------------------------------------- --------------•--•--------'------------------•--•-' - r- ----------•----------------------------------------------------------•-----•-----`------•----------------`---------••-------------------.-----------------------•---------•----••--•---•--------•----•------------------ I .hereby certify that I'have prepared this application and`+ha+ the work will be done in accordance with San Joaquin County + ordinances, S�te�law and,xules�and�ations of he San Joaquin Local Health District. (Signed)---- , ---------- Contractor) -- - ------ ---------------------------------------------------------(Title _ _ (Plot plan, showing size of lot, location of sysfem in relation to wells, buildings, etc.; can be placed on reverse side). a FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BYC� '- - •------------ DATE CA- - — -------------------------------------------------- REVIEWED BY ------------------ --- ------------------ ----------------------------------------------------- DATE__ "; •---------•-------- UILDING PERMIT ISSUED-----=------------------------------------------------------------- ---------------------------------- DATE----- -- Alterations and/or recommendations:-------------------- ----------------------------------------- ----------------------------------- ----------------------------------•---------- ------------------ ------------._ - -----------------------------•--•--------------••--••-------------•-•----- -------------------------------------------------------- -------- •---_1------- ------- - ------ �r - --- -- •------•------•------- FINAL INSPECTION BY------------------------ � ---- -�---------- Date l; 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 149446 ATW00a "Z_54