3443 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No -'` - - _-_-- .. (Complete in Duplicate) Date Issued Application is here 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 wit Count O i ante No. 549 JOB ADDRESS LO ATI ) -- Ownsr's Name_ _. _.-;___ -- ---------------------------- Phone. --------------------------------- -- -• -----•--- - - -------•-- --------------------------------------•-------------------------------------•------- --------------------------------•------•-------- Contractor's Name___ _ _____ - -________ _ - - ----------------- ------ -- --•------••---------•-----•----- -------------------------------- I---------- Phone--------------- Installation will serve: Residence Apartment House ❑� Commercial ❑ TraileL Court // -+1F ❑ Motel ❑ Other ❑ Number of living units: _T____ Number of bedrooms --_�__ Number o aths ./____ Lot size __ c __.x__la - + f . Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy LoamClay Loam E] Clay E] Adobe R"'Hardpan ❑ Previous Application Made: Yes [INo New Construction: Yes [2 No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if p licrsewer iavailable within 200 feet. r Septic ank: Distance from nearest well_ 0uistancp fro fou �aiion_' at�oLi No..of compartments---- --- _ I-----'Si ea_)t ' 'T Liquid depth---------- - Capacity-, Dispos Field: Distance from nearest w I-- -- --------- Number of istance from foundation__ -Distance to nearest lines : Length of each lin e---------- __ -r ---Width of trench______j'V- T ` e of filter materi #( Width -- --- epth of filter material-------e_ -----Total length_____- 6.___ _-- Seepage Pit: _. Distance to nearest well__- .________.._______Distance from foundation------------_-------Distance to nearest lot line__-___.._______-_ ❑ Number of pits---I-----------------Lining material-----------------------Size: Diameter-------------- --------Depth------ ------------------------ Cess Cesspool: 1 p Distance from nearest well----------_------Distance from foundation-------------------.Lining material------------------------------ I Size: Diameter Depth------------------- ---------------------------------Liquid Capacity.. gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building ❑ Distance to nearest lot line__________________________________ Remo lin and/or'repalr -fde c IS ---•------------------------- -- _------•----------•-•----------------------------- ----------------------------------•-•-------------------------•-------•-------------------------- - ------------- ----- ------------------------ -----------------•---•------------•------••---------•--------------------------------•-----------••-----•-------------- ------------------------------------------ ------------------- ------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, S to laws, and rules and{regulations of the San Joaquin Local Health District. (Signed)_ _•_____ _ __ __ . ____________________(Owner and/or Contractor) By:------------------- Title ----------------------- - (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on'reverse side). i ' --------------- 1 FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY •-----------------------------------------------------------•----------= DATE`------------------------------------------------------- -------REVIEWED BY =---------- ---- --- ------------------------------------------------------------------------------- DATE__ BUILDING PERMIT ISSUED ----------------------------------------------------- DATE_. __. Alterations and/or and/or recommendations___________________.__--______. ---- ----------------------------• --•------ - --------------------- ------------------------------------- A FINAL INSPECTION BY:--_-.____ _ c3 i '= f Dat _ e. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Stockton,.Caiifornietreet Lodi, CaliforniaGlifiMentees, California Tracy, California FS--9-2M 10-52-Revised W-2100