11115 - Laserfiche WebLink

Home Browse Search

yQ ` APPLICATION FOR SANITATION PERMIT V Permit No, {Complete in Duplicate) r {. Date Issued --- �t1 Application 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:"v` 3,�(y E. H 0 rte. C_-U, I � i _ I -O-(, JOB ADDRESS AND I OCATJON�/),__.__ _ _'" r�- ..,-r ------------------- Owner's Name------ __./ f - "xt Phoned ` Address---------/?w, IZ " /Z - ----------=-------------------------•-------------------------------------------- •-•------....------------------ Contractor's Namer,- - E" `' • ------------------------•--------------•------- Phone Installation will serve: Residence.Q Apartment Hous❑ Commercial E] Trailer Court El Motel p Other Number of living units: _�_ _ Number of bedrooms _.3___ Number of baths __j____ Lot size --- Water Supply: Public system C] Community-system ❑-Private„0_D.epth to Water TableS�_- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑'ySandy Loam�fli` Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ Noi© New Constru tc ion: Yes ❑ No Z FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) t 1 1 7 Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material-_____________.__.________.._______.____.____.. j ❑ No. of compartments'--------- --------- Size--------------------::_ ��--Liquid depth-------------------------Capacity-------------------- - s Disposal Field: Distance from nearest-well'"`_-r.__.__ .Distance from foundation--------------------Distance to nearest lot line--- ❑ Number of linesA;:----1�------ #-�----------1--Length of each line-1 __________ ---------------------------Width of trench----.----•------------------- Type of filter mater{al __-- �----------- --Depth of filter material---------------- _ _ _ ----Total length______-_-___ _____ _ -- - ----_-__-------- ---- Seepage Pit: Distance to'nearest--------- --- -------------------------- Cesspool: ---Distance,from foundation------}_0_�----Distance to nearest lot line_-�________. Number of its______-_ ------ Linin material _. _ ........ Depth •eZ`�------------------ _ p S ize: Diameter Cesspool: Distance Ifo nearest well------ Distance from foundation---._.__--- --____.Lining material--------_______________________ _. ❑ Size: Diamefer--------------------------A------Depth----------------------'r---------------------------Liquid Capacity---- „----------------_9al . Privy: Distance from nearest'well_____._----------------------------------------- �,. �� Distance from nearest building--------------------------------------- - �. ❑ Distance to nearest IotLine-- -------- Remodeling and/or repairing (describe):_.____ --I------------------------_-------_-------_ ----------------------------------------------------------------------- --------------------------••---------------------------------------=--------------------------•----------------------------------=-----------------------------=------------------------------------------------------------- ------------•----------•----------------•-----•-------•----------------•---------------•--------------------------------------------•----------------------------------- I 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. 6(Signed)-,`�--�'tr ------ __ r * l_ ---------------------------------------------------(Owner and/or Contractor) By•---------------------- ---------------------------------•---•---------------------------------------------------------------------_(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 ------------------------ DATE---------- ff BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE f Alterations and/or recommendations:----------------------------------------------------------------------------------- ----------------------------------------- -------------------------•------------------------•---•-------------•-------------------------------------------•------------ ------------------------------------------I-------- FINAL INSPECTION BY:.-� ------------------------- Date---f.'/ 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 1-57 F.i'.CO.