7409 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. _.-.l--__..__.0_/ (Complete in Duplicate) Date Issued -_ --- Applica+ion 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 Codri,i/y Ordinance o./549. J JOB ADDRESS A OCATION_ __1 ._.- -------•--- wner's Name--- --._ -------•----- -- ----------- ----------- ----------------------------- -------- -.. Phone----- ------------- Address--------- Contractor's ________ontractor s Name------ ---•-•--.--- Phone.. Installation will serve: Residence [►Apartment House ❑ Commercial ❑ Trailer Court ❑ Mofe [] Others❑ Number of living units: ---il-_ Number of bedrooms _Z_-Number of baths --L- Lot size -_ 19 - * . Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table ----.--- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes [] No ❑ New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feeft) " Septic "ank: Distance from nearest well"* --- ---- Disfiar fro fours $tion , ' �✓ No. of compartments.-..---. _. - - - -----.Mat i�I---- ----- ----------------- --- ---- Size77 1 -----Liquid depth_`. Capacity �� ,, -, Dispos 1 Field: Distance from nearest well _ --_- --_Distance from foundation _T Distance�to nearest lot line-_ ''�-*�{ Number of lines -._-_.-- - _.+s .-.-- Length of each line------ -------d- _ f -------------- TypeF ----�f Q-� - .�rf"� Width of trench--- ----- --`�' - .. of filter materia - �l ---- -- +--- --------- epth of filter materialf _ _- ----Total length-----------�--�-�--,------- 5eepage Pit: Distance to nearest well----------------------Distance from foundation----------------.--.Distance to nearest lot line-----:-.-_.---__ ❑ Number of pits-- ---------------Lining material-----------------------Size: Diameter------------------ ----Depth--- -------- --- ---- f ------ Cesspool: Distance from nearest well----------------- from foundation---------___------_Lining material--__----.- ------ -------------------- Size: Diameter-------- ----------- ---- - --- ---Depth----------- -------- - - - - - -- - - - I ----.-Liquid Capacity- ----------------- - Priv c gals. \ a Y Distance from nearest well . Dis#ante from near f building----------- -------------------------- -•- ❑ Distance to nearest lot line-----------------_-.--------._ - Remodeling and/or repairing (describe------------------------- -- . -------------------------------- •----------------------------- ---------•------•---- --------•----•--------------•----------------•-•-----------------••----------•-------• ---------------------••------••----•---------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County n' t ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)- -••---- -_ ----- -----". ---- Q (Owner and/or Contractor By:----------------------------------------------- -------------•--------------• - f Title (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__-------- --------- --- ---------- --------- ------ REVIEWED BY .S -------------------------------- .. ------------- ----------- ------ DATE-- BUILDING PERMIT ISSUED t1�s -----------------•-•---------•--------- tl------------------------------------ - ------•.... DATE-------�T------ A i<eraiohsand/or omme n+°dry tYvn _ t.n ---•-----••- -------•----------------------------------•----------- , ou.. ,- � ...0 - FINAL INSPECTION BY:-___-. - Date. �q �-- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California i Lodi, California Manteca, California Tracy, California EE.-9-2M 145446 ATw MDD 12-54