2893 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT ermit No. (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. i This application is made in compliance with County Ordinance No. 5491 JOB ADDRESS AND LOCATION--------- - fr Owner's Name----------------------------------------------- -- ---- Address. --Address. -------------------- y- -------------------- -----------•------------- ------------------------------------------- - . Phone--- �7--------,. - ----- Contractor's Name Installation F will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ , Number of living units: _ _____ Number of bedrooms __ Number of baths .______ Lot size J_-2- Water Supply: Public system © Community system E] Private gr- Depth to Water Tablet. Character of soil to a depth of 3 feet: Sand Gravel Sand Loam Clay Loam Clay Adobe Hardpan P ❑ ❑ Y ❑ Y ❑ Y ❑ ,� P ❑ Previous Application Made: Yes ❑ No New Construction-, Yes." No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) y ,� Septic Tank: Distance from nearest well_�Di_Distance from foundation_` _______.Material--------------- ''-`- __________. No, of cam artmerts______ Size__ " p i�----------------- ��----------- ---._Liquid depth----��-"2--------------Capacity---Y___7_1 ------ Disposal Field: Distance from nearest well_�a......Distance from foundation_ __"____Distance to nearest lot line.___._,_. Number of lines_________-__� _��__ _______Length of each line---- ---- of trench__ ____V'_----------------- Type ______________ Type of filter material---/_�1-___ ----Depth of filter materia___f8 -------Total length------- ,_I:7_r-___________________ Seepage Pit: Distance to nearest well__M-47--------Di ante from fo datio ---- to nearest lot line____S______ RZNumber of pits-------/------------Lining m erial-[�________�---Si : Diameter---J.�_ s___Depth_____�.T-�_____________ Cesspool: Distance from nearest well-________________ _stance from fo ation--------------------Lining material-------------------------------------- El Size: Diameter--------------------------------------De -----------------------------------------Liquid Capacity---------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ El Distance to nearest lot line------------------------------------------------ -- ------------------------------------------•----------------------- Remodelingand/or repairing (describe):--4�--------------------------------------------------------------•--------------.....-•_--•'---------------------••--------------------•--- -----------------------------------------•---------------------------------- ---------•-------------------------------------•------•----------------'-•••----------------------------------------------------------- -----------------------------------------•----------•-•--------------•-------------------------•------- --•---------•---------------------------------------------------------------------•----------------------------------_ 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 +ke San Joa�,i�n Local Health District. (Signed) � �-�4 - ------�--�---"�'�----------------------------------------------------- g ) Contractor) Ely---- ------ --------- ------ - - - --------------------------------(Title)-----Ei�'_ l�I? -e --------------- (plot plan, show g size of lot, locatio of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------- ------------------ ----------------------------- ---------- DATE---- - --�^'.- REVIEWEDBY--------------------------------------------- -- --------------------------------------------------------------------------- DATE - BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------------------------- DATE--------------------------------- --------------------------- Alterations and/or recommendations----------------------------------- -------------------- ---------------------------------------------------------- -------------------- ----------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------I---------------------•--- ----------- ----------------------------------------------------------I---------------------------------------------------------- --------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------ ---------------------------------------------------------------------------------------------------------------- FINAL INSPECTION BY: W—)VI--- ------------------------ Date----------- ----- -- - ---- . - ^ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Sfreet 132 Sycamore Street 814 North "C" Sfree+ Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 8-51 Revised W-2100