8690 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Pr Emit No. ._ j� __ (Complete in Duplicate) . ° a e -----1 ----- Application is hereby made to the San Joaquin Local Health District for a permit to co struct an th or D aereio4escribed. This application is made in compliance.with County Ordinance No. 9. {� z: JOB ADDRESS AND LOCATION v- Owner's Name--------- ��d r✓ ' hone Address -------- -- c= r - ---------------------------------------- Contractor's Name •flil,/ ------ Phone--------- ------------------------- Installation will serve: Residence �Apartment,House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _ ___ Number of bedrooms - __ Number of baths --- _ Lot size 1 Water Supply: Public system Community system_❑ } Private ❑ Depth to Water Table Character of soil to a depth of 3 feet: Sand ❑ G`ravel ❑f Sandy Loam❑ Clay Loam ❑ Clay ❑ Adobe 6"OHardpan ❑ Previous Application Made: Yes ❑ No Rq"*"New Construction:- Yes ❑ No ErFHA/VA: Yes ❑ No [ -- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or`cesspool permitted if public sewer is available within 200 feet. ep yTan Distance from nearest well_________________Distance from foundation--------------------.Material ____-_-______._________________.__.___-_______- No. of 'compartments--------------------------Si-ze-'_--------: Liquid deth- ---------------- Capacity Field: Distance from nearest well.-----------------Distance from.foundation--------------------Distance to nearest lot line_________________ Number of lines--------- -------------------------Length of each line------------------------------Width of trench----------------------------------- T e of filter material-__._ J__Depth of filter material________-______;___._Total length________________________:_________.__.- Yp s See a Pit: Disfance to nearest well__ _ Distance from fou ation___, p --- - ,to nearest lot lin` _ Number of pits-_____/__________Lining"material/f_/�_ _� _Size: Diameter_--- -___-___:Depth...... ,1__-� ______ Cesspool: Distancerfrorn nearest,well--------F------Distance from foundation___________________Lining material____---_____--_____-________________. ❑ Size: Diameter-- ---------------4---- ----------Depth----------------------------------------------------Liquid, Capacity---- ------gals. Privy: Distance from nearest well_____________________________-____-______-...-Distance from nearest building------------------------------------_----. a ❑ Distance-to nearest lof-line.,---------------- - ---�------------------= Remodeling and repairing (describe): - �_____-___ ��- ----•-•----------------------- a i, — I hereby certify the+ I have prepared +hiskappiication 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. (Signed) �'.'-�J-- -------- ---- - Contractor) I By: -------- -- - ----'r--------------------------------------------------(Title)---1 �----- --- - -------- (Plot plan, showing size of , -location of system in relation to wells, buildings, etc., can be placed on reverssided/ ). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------------------------- ----- -------------------------------------------•---------------- DATE.--- REVIEWEDBY--------•----------------"-------------------- ------- ---------------------------------------------------------------- DATE---- % ... - - BUILDING PERMIT ISSUED-- :---- --------------=------ ---- --------------------------------- ------------------------- DATE------------ --- � Alterations and/or recommendations--------- ---------- - ------------------------- ----------------------------------•------------•------- �.. i ---------•-----------------------------------: ------ - ------------ ---------------------------------------------- - ------------- .�'L -•------ ---- --•--------------------------- --- ------------------------------ ---------------------- - -•------------------------------------------------------------------------•---------------------------------- FINAL INSPECTION BY:---------------------------------- ----------- ------------ Date--- SAN ate--SAN JOAQUIN LOCAL HEALTH DISTRICT. 130 South American Street 300 West Oak Street 132 Sycamore Street 814 Norfh "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Reviseri 1.57 F.P.CO.