509 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) 4 . /,-, Application is hereby made to the San Joaquin Local H a4#h District fora per to construct an nstall a work herein described. This application is made in compliance with Count Ordinance No. 549. ----------------- JOB ADDRESS AND LOCATION-------------_ ---------- -- Owner's Name------ ------I&--------------•------------- --------------------- ------------ Phone----------------------------------- Address-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Contractor's Name.... -------------------- Phone----------------------------------- r Installation will serve: Residence 9- Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other [I/; * � Number of living units: [I Number of bedrooms V Number of baths [/ Lot size__. ---t4s_x-------- ------ x 1 � a Water Supply: Public system F1 Community system ❑ Private ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan D"k, TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.] Septi Tank: Distance from nearest well----.�__ _ �Distance from foundation----- d____.___-Material_.______�--------------- - /, _r--------- .,� No. of compartments--------------�~"-----Capacity----- _ --[�_----size------ F---.,Liquid dep#h--�---�------------ cesspool. Distance from nearest well-----------------Distance from foundstion_____--___________.Lining materia___________________-_____________ --- ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------- j` -----------Distance from nearest building-------------------- ------------ Privy: Distance from nearest well______________________________________ ❑ Distance to nearest lot line------------------------------------------------ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line___.____________. ❑ Number of pits-----------•----------Lining material-----------------------Size: Diameter---- Depth / Dixal Field: Distance from nearest well_____ , ___Distance from foundation----e_g___f-----Distance to nearest lot line-5-7-9----- Number of lines-----------------r_2-----+� -ength of each line-___________s�`QWidth of french--------------------------------- Type _-__----- -----------------Type of filter material_______'I'- J441t5epfh of filter material---------- ------- Remodeling orad/or repairing (describe):______ _____ ____________ __ _ __�-- - ----6-1--------- -------------------------------------- . -�- - "- _ - - ----------------------- -------------------- ------------------------------------ ----------------------------------------------------------------------------- --------------------------------------------- ----------------------- 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)11he San Joaquin Local Health District. (Owner and/or Contractor) - By- ------------ Title --( ---------------------------------------------------------------- (Plot plans, s owing size of lot, location of system in relation to wells, buildings, etc., must be filed with this application]. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY___ --- --------------------- DATE-------------"� ----------••---- REVIEWED BY----------------------------------------- ------------- ----------------------- ----------------- - -------------- -- ------- DATE BUILDINGPERMIT ISSUED--------------------------------------------------------------- ----------------- DATE----------------------------- ------------------------------- Alterations and/or recommendations---------------------- --------------------------•---------------------------------------- ------------------------------------------------------------------------------------------------------ ------------------•--------------------------------------------------------------------•---------------------- ---------------------------------------------- ------------------------------------------------ -------------------- -----------------•----------- ------------------------------------------------------ ------------------- ----------------------------------------- ------------------------------------- ---------------------- PERMIT No.____S:Z--7--------- ISSUED---•'V- 4f-S_j------(Date) FINAL INSPECTION BY------------------ ---� ----------------- ----- Date----------------!___J-_ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES--R-2M 9-50 W=1639