4652 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) . l Date Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work htZscribed. Thisapplication is made in compliance with County Ordinance No. 549. JOB ADDRESS AND CATION- ____. d Owner's Name---- .- • _-r Address --- ------------ Ph IF�/`' ------ ------ � •` �X�,( _ �.r �`-'[ Contractor's Name----- •----•------...._ Phone : ��°7 Installation will'serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: -!.__ Number of bedrooms ---L.. Number of baths 1 "•'. ❑ Lot size _64._�--1�------------------------------- Water Supply: Public system ❑ Community system ❑ Private K Depth to Water Table -_ �5"ft. Character of soil to a'depth of 3 feet: Sand p _Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ . Previous Application Made: Yes ❑- Nolo New Construcfion: Yes ❑ 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---------------- - ----Capacif Disposal Field: Distance from nearest well_ Distance from foundation__I �-- / .Distance to nearest lot line- Number of lines---(TW -.-.-_-__Len th of each line___ ` g -------------•----.Width of trench � "�� Type of filter material:--- _- Depth of filter material________________ ------ -------- Total length------------------------------ Seepage Pit: Distance to nearest well-.__-_--_--___-------Distance from foundation___ Distance to nearest lot ❑ Number of pits----------------------Lining material----------------------.Size: Diameter-----_------- Depth ----------------- - Cesspool: Distance from nearest well-----------------Distance from foundation_-------_---------Lining material------------------------- -- ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity--------------------- -------------ga-ls. Privy: Distance from nearest well .___ -.----Distance from nearest building---------------------------------❑ Distance to nearest lot line_________________________________ - ------------------------------------------- Remodeling and/or repairing '(describe):____ ----------- � �' elf ------------------- -------- _ _-- ---------- ------ - ---- I hereby certify that I have prepared this application and that the work will be done in accordance- with San Joaquin County ordinances, Slc el'1 V_s, and r les and-reguliftions of the San Joaquin Local Health District. (Signed)_ ` - i r - , - ----------- --- - (Owner an for Contractor) ---- gY� �/.. _ --------(Title ) .. (Plot plan, showing size of lot, Iocation`of system in relation t Y Y wells, buildings, a+c., can be plat on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------------- ------ -- ------------------------------------ ------------------------ DATE- - -a.=+ REVIEWED $Y---------------•-- ------------------ ---- - � - - - - DATE_ BUILDING HERMIT 15SUED --- - --- ----- -------------------------------------- DATE- ----------------- Aterations and/or recommendations:_..,'__._.__ ---------------- -------------------------------------------------------- ........ --- --- ------------------------------ --•---------- - ------------------- ------------------------ FINAL INSPECTION BY:----------------------------� �� 4 —s — ...--- Date--- ------- ' SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street y Stockton, California Lodi, California Manteca, California 814 North "C" Street Tracy, California ES-9-2M 10-52 Revised W-2100