2181 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No.,aTd_-_/------- (Complete in Duplicate) Date Issued 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. JOB ADDRESS AND LOCATION_ --------------------------------------------- --•- Owner's Name__ ---- ----- ' -R-- ---- ----------- -------- ----------------- Phone------------------------------------ ------------------------------------------------------------•---------------•-•------•-----------------------• Address---�_.p� a------ -�------- --- ---'----- & -------------------------------------- - Phone. „�w- ��------- Contractor's Name----�_,��_�----��----�" � ---------------------------------------------------------- will serve: Residence x Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -- Number of bedrooms .9r. Number of baths _- ---- Lot size ___ A----1-�Pt--- _____ ------------------- ---- Water Supply: Public system x Community system ❑ Private ❑ Depth to Water Table _A/A06ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[% Hardpan ❑ Previous Application Made: Yes ❑ No 9 New Construction: Yes ❑ No te, I TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest wel ►,&Zrr __Distance from foundation__Lo?-----------Material--- __________________---------. No. of compartments------- ------------Size_-"_ _- �'r+_ _Liquid depth----S-A------------Capacity--- D10------ ________Distance to nearest lot line________________ `s Disposal Field: Distance from nearest well----------------- from foundation_______,__ Width of trench______El Number of lines--------------- -----------------Length of each line------o-,,2---------------- Type of filter material-------------------------Depth of filter material______________________Total length__/.2-_--- __.._P _____ Seepage Pit: Distance to nearest well-02."i - "---Distance from foundation__,c7a.__------Distance to nearest lvt line-'' Number of pits (:?a material___ Q�- P--Size: Diameter----- -----------Depth---- --------•---- ' Cesspool: Distance from nearest well_______________Distance from foundation____________________Lining material___________-._____________..____._ ❑ Size: Diameter-------------------------------------- YDepth---------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest 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 ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. f k io"Re""Im/or Contractor) ' (Signed)---4)-°A!-- �� ------------------- { (Plot plan, showing sixe of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY- ----------------------------------------------------------- DATE--�-------------------------------------------------- REVIEWED BY --------------- DATE BUILDINGPERMIT ISSUED----------------------------------------------------------- -- ------------------------------------- DATE---------------- ---------------------------------------- Alterations and/or recommendations------------------------ -- - -- - -- ----------- ------------- ------- --------------------------------------------------------------------- - --------------- r ------------------------------------ -------' ----------- =----------- ----�-- - -`° - __^ -- -- ---- ------ ---- -------- --=------- ------------------ FINAL INSPECTION BY:--------- ---------------------------------------- V_-/�-------- - --------------------------------- Date ------------------------- ------------------------•---- 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 8-51 Revised W-2100