5443 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No.1___yy�._ (Complete in Duplicate) Date Issued AppiicaTion 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 ounty Ordinance No. 549. vt JOB ADDRESS AND LO TION ----- - - -- ---------- ------ ---- --- - v Owner's Nam l/1///.-,r//•,/ -----...------------- ------------------------ ----------------------------------------- -- Phone------(J/_----- ----- P Address ---- --- ----- --------------------------------------------------------------•-- ¢¢ Contractor's Name--------- --- ---- -- ---------------------- - -- '------------------------------- -------------------------------------------- Phone_..---- -L_Z Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___1___ Number of bedrooms _z& Number of baths _1___ Lot size _4.A0___x_` _ _____________ ___________ Wafer Supply: Public system ❑ Community system R-xprivate ❑ Depth to Water Table __;V - Character of soil to a depth of 3 feet: Sand P Gravel ❑ Sandy Loam Z Clay Loam E] Clay E] Adobe E] Hardpan ❑ Previous Application Made: Yes ❑ No El"" New Constructio : Yes 0 No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) }` Septic Tank: Distance from nearest well_________________Distance from foundation--------------------Material------------------------------------------------- ❑ No. of compartments------------------------.Size--------------------------=-----Liquid depth--------------------------Capacity----------------------- Disposal Field: Distance from nearest well.___._._Distance from foundation-___/&f �_.--.Distance to nearest lot line_--�....... ,Y/ Number of lines_____________ _�___ -_-.__ Len th of each line_________ __.a ' Width of trench-_ --- Type � 9 �q }} / ---------- ---- Type of filter material 1__�._.i/�F___Depth of filter matenal_-____-.__�_-_-____Tofial length__. _ __� �______________? Seepage Pit: Distance to nearest well_____----------Distanc from fou ation___.�...___..Dis a e to nearest lot line-----AS__ Number of pits....________________Lining material_._C r_ _�_ __Size: Diameter_____ � ._ Depth-----vZ�I_______--______ 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-------------._-___-----_______________._. ❑ Distance to nearest lot line_________________________________ Remodelingand/or repairing (describe):------------------ ----------------------------•------------------------------------------------------------------------------------------------------- t ---------------•------•--.......------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- - --------------------------------------------------------------------------•-----------------------------------•-------------------------------------------------------------- -------------•--------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State Iand rules and re ulations of the San Joaquin Local Health District. , r 4 {Signed------------ -------- ------------- --- -------------- -------------------------------------------------------- -and/or Contractor) By:-- ------------------------------ ------- (Title-- y -.......................... (Plot plan', showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- ------------------------------------- ---------------------------------------- DATE . REVIEWEDBY----------------------------- ------------------- ------- - --- --------------------------------- DATE----- --------- BUILDINGPERMIT ISSUED_---------------------------------------------------------------------------------------------------- DATE--------- : ---- ----------------------- - Alterations and/or recommendations:----------------------------------------------------------------------------------------------------------------- ---------------------------------------- I ---•------------=------------------- --------------------------------------- ---------------------------------------- ------------------------------------------------------------•------------------------------------•------ u -----------------------------•---------------------------------------•-•----•----------------•-•-------- FINAL 1kINSPECTION BY-------------i----- /_; ,- �3--------•----. 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 Revised W-2100