5723 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. (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 County Ordinance No. 549. JOB ADDRESS AND - - --------- --------- ------------------------------------------------------- 'LOAT --------- ---- ------ � - - -, Owner' ------- --------------------------------------------------------------- Phone Address. Contractor's Name------------ -Q: ; - ------- Phone, Installation will serve: Residence Apartment ouse E] Commercial Ej,. Trailer Court E] Motel ❑ Other 0 '0 -Z-f- Number of living units: Number of bedrooms -<-7-- Number of baths -/--- Lot size --- /�. --- — -------------------_____ Water Supply: Public system * Community system El Private E] Depth to Water Tabl§04 ft. Character of soil to a depth of 3 feet: Sand E] Gravel F] Sandy Loom Fj Clay Loam E] Clay E] Ado Hardpan C] Previous Application Made: Yes [] N �1� New Construction: YAE] ff", No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T nk: Distance from nearest well ------------------ Distance from foundation -------------------- Material ------------------------------------------------- No. of compartmenfi -------------------------- Size -------------------------------- Liquid depth -----T - --------Capacity- -------------------- D pos -------Capacity------------------------ DtpoZsjF d: Distance from nearest well---_-----.___-_ Distance from foundation --------------------Distance to nearest lot line_________________ Number ine----------------- Number of lines ---------------- ------------------- Length of each line ------------------------------ Width of trench----------------------------------- Type rench----------------------------------- Type of filter material ------------------------- Depth of filter material ----------------------- Total length__________________ __ �" Seepage ength---------------------------------------- Seepage Pit: Distance to nearest Distance fAtI.M. founikion-A40- ---- Disfince to nearest lot line.---4-7- Number of pifs --- / --------------- Lining material_ Size: Diarnefer-7 ----------------- Depth.----_,;? ----------------- from nearest well ----------------- Dist e Cesspool: Distance f�-from foundation -------------------- Lining material_----_____________________________. ❑ aterial----------------------------- ---- F-1 Size: Diameter --------------------------------------- Depth ------------------------------- ----------- -------- Liquid Capacity -------------------------•--gals. Privy: Distance from nearest well ------------ ----------------- 7- ------------- Disfance from nearest building________-____..__.___.___-_ -_-----_...- ❑ uilding-------------- ---------------------- El Distance to nearest lot line----------------------------------- --- P11 ------- - ---- --------- --- ---- -- ---------------------------------------------------- Remodelin re a' _describe):-- ----------- ---------- --- ------------------ - ------ - ---- -- ---- --------------- ------------------------------------ ------------------- ----------- -------- --- ----------- ----------------------------------------------- ------ -- - ----- ------------------------ I ------- - ---------------------------------------------------------------------------------------------------------------------------------------------- -------- - -----------------------------------------••--------•-- I ------------------------------------------------ ------------------------------------------------------------------------------------------------------------------ I hereby certify that I have prepared this application and that the work will be clone in accordance with San Joaquin County ordinances, St laws, and rul s and re 1- 'io s of the San Joaquin Local Health District. (Signed) ----------- .............--Owner WContractor] By:--------------------- ------- ------- ----- -A-- ---------- ------------------------------------------------------------- (Titl (Plot plan, showing size of Iot, 10 ion of system in relation to wells, buildings, etc., can be p on revers FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------------- -- DATE.-------- -- ---------------------- ------------------ REVIEWEDBY--------------------------------------------- ------- -- ------------ ------------------------ ------------------------ DATE ------------------ \ --------------------------------------- BUILDINGPERMIT ISSUED ----------------------------------- - --------------------------------------------------------------- DATE------ ---------------- ---- --------------------- -- Alterafions and/or recommendations: ----------------------- \4rN ---------- --------------------------------------- -------------------------------------- .... -- --------------------- ------------------------------------------------------------------------------------------------------ --------------------------------------------------------------------- ---------- ----------- �-------------------- --------------------------------------- -----------------------------------------------------------------------------------•------------------------------------------------------------------------------------- -I ------------------------------------------------------------- -------------------------- -I ------------------------- --------------------------------------------------------------------- - ------------------------------------------------------/--------------- ------------------------- FINAL INSPECTION BY:----- --------- ---------------- --------------------------- Dafe-e/--- 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 -9-2M ; . Revised W-2100