SR0049059 SSCRPT - Laserfiche WebLink

Home Browse Search

V APPLICATION FOR SANITATION PERMIT Permit No. r�pf (Complete Com lete in Duplicate) Date Issued ---••--- -�- , A plication 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 A LOCATION._.. __ - --_ --__ - -----------•-----•--__ ----------- ------- - Owner's Name Y Phone �I Address .. .0 -------• ------------------------------------------------•-------------------------------------.._----••---- Contractor's Name------------------ Phone •�----- •-------------------- . ` ... Installation will serve: Residence JZ Apartment House ❑ Commercial ❑ Trailer Court ❑. Motel ❑ Other ❑ Number of living units: _I___ Number of bedrooms -_ '_ Number of baths.__- Lot size ___- ------- _ ..............Water Supply: Public system ❑ Community system ❑ Private X Depth to Water Table .y4. ft. Character of soil to a depth of"3 feet: Sand ❑ Gravel ❑ Sandy Loam I] Clay Loam ❑ Clay ❑ Adobe,® Hardpan ❑ I Previous Application Made: Yes ❑ No 9 New Construction: Yes ❑ Nox TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) �e ank: Distance from nearest well_________________Distance from foundation--------------------Material______..______.____.-__________._______-_-_____. No. of compartments-------------------------Size------ •------------Liquid dept------------------------•-Capacity------------ Disposal Field: Distance from nearest well--- from foundation______Q_ __.Distance to nearest lot line_--_3�-_� Number of lines__•____________ Length of each line-------6s_............Width of trench.____2_Y��-___________.__ Type of filter material ______ p " -" �-_.._Depth of filter mater"al___---�,�'`.--_--_---Total length-----•--P�, -_____--•--•----__--•- " Seepage Pit: Distance to nearest well---------_------------Distance from foundation--------------------Distance to nearest lot line__..-_-.________- i ❑ 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 buildin g -----------••------•----•--------- ❑ Distance to nearest lot line--------------------------------------------------•=----------- ------------------------------------------------•-------------------- r Remodeling and/or repairing (describe);------ -- .. ,. -- ---------------------------------•------- ----------------•------------------------ --•-•----•---------•---------------------- y-'-"-_'-^I------------------------------------------------------------------------------------------•-----------------------•--•-------•------•--•----------•------••----•--- ------------------•------------•-------------•-------------------•-----_-•--------....................-------------------------------------•------------------------------------------------------------- ------ Y I hereby certify that I have prepared this application 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) _ _ __ _ �_ _((?yn6r and/or antracfor ] U.Ji By: ----------- - --- •-- •-----•-- ------------------------------•--•-----------------------------------{Title] (Plot plan, showing size of lot, location o system in relation to wells, buildings, etc., can be placed on reverse side]. FOR DEPARTMENT USE ONLY p APPLICATION ACCEPTED BY.- REVIEWED DATE ,c_." � i REVIEWED BY...... - ----------- -------------- DATE------------• ... BUILDING PERMIT ISSUED-------------------------------------------------------•-••------------------------- ------------ DATE-----•--... Alterations and/or recommendations:----------•---•------------------------------------------------------------------------------- Fi --------------------------•---------------------------------•-------...------------------••-•-------------------------------...---••------------------------------------...----------------------...-------------------•----- ----------.-..•-----------------------------------------....................--------- ----------- ------------------_____.,_______-___-__-___-_-_-________.-._________._____-_____-_______....__..______f____-.-_-_______________.-..._______________-____..__.__________-_-_____.._.___________.._......____.__..._.___......._. rf I � r, FINAL INSPECTION BY:--------------- Date------- ----------------------------------------------- SAN --..__ ` _. _ ._ ._------------------•-----------SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American sfreet 300 West Oak-Sfreef- 132 sycamore Streef 814 North "C" Street +" Stockton, California Lodi, California: Manteca, California Tracy, California f i E5-9-2M 10-52 Revised W-2100