3649 - Laserfiche WebLink

Home Browse Search

ti APPLICATION FOR SANITATION TION PERIv11T Permit No. t (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. 5 9. JOB ADDRESS ANDOCATION___-_"___-f_ jG_1 y - -----------•----------------•--- Owner's Name.------- a ------ v Phone......,.1�..�a'� _p- Address------------- ter''_. ----------------------------------------------------------------------------- ----•---------------------------------------------------------------------- ---- Contractor's Name —.--------------------------------- --- ------------------ ---------------------- Phone.---•-----------•----------•-- { Installation will.serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --___ Number of bedrooms __ Number of baths J----- Lot size __:�j- � _--/� ------------------------- } Water Supply: Public system' Community system ❑ Private ❑ Depth to Water Tablea-�ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ NoNew Construction: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I Septic Tank- Distance from nearest well-,?' _r'Distance�from foundat n__ ---.Material __ , J ___ ___ __ _______ f ` No. of compartments____ ---------------Size...-��• -Liquid depth__.'_ ___ __Capacityar✓--t Disposal Field: Distance from-nearest well---.________.__Distance from foundation___________________Distance to nearest lot line____--___________� ❑ Number of lines --- ------Length of each line--------------- ------------- Width of trench---------- Type of filter material-------------------------Depth of filter material-----------------------Total length-------- Seepage Pit: Distance to nearest well 1 } yyt�I_____D•sstance m f ndation��--_-_---.Disi�nce to nearest lot line__.____ X11 1 X1 Number of pits.-_.__-/___________-Lining materiae---Size: iameter___-�_l_______._ •�` i r Deptn f��/ - --- Cesspool: Distance from nearest well-----------------Distance from foundation.--------------------Lining material---------------------__-- Size: Diameter- = Depth Liquid CapacitY--- ------------------------------------gals. Privy: J Distance from nearest well-------------------------------------------------Distance from nearest buifdin ❑ Distance to nearest lot line--------- ---- 9 Remodeling and/or repairing (describe)_______________ j -------------------•.--------------•------••-------------- ----- ---------------------------------------------------------------------------------------------------------- ---------------------•------------------------ -------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State s, andel I rand regulations of the San Joaquin Local Health District. or {5�gned)___________ -- -------- �r�, (Owner and/or Contractor) -------------------- By:------------- � = ------------------------------------ Title ! (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be p ac on reverse side) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _. ------ DATE ------------------------------- ------------- REVIEWED BY - -_ __- - -- ------------------------------ --�--------------- -------------------------------------------------------------- DATE_-�' ------------- - ----------------------------- BUILDING PERMIT ISSUED - --------- DATE------ ------------------------- -------------- ------------------- A terations and/or recommendations:__________________________ -------------------------------------------------------------------- ------------------------------------------------------------------•------ -------------------•--- ---- ---------- ----------- ., I FINAL INSPECTION BY--------------- --------------- Date---- -------#-i,/ 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 10-52 Revised W-2100