13178 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit 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. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS A D L CATION-.�00__ -_ __!_ ___ __ -- __�____ _____ ______ _ Owner's Name ------------ Phone--------------------------- / -- ------------ ------- ---- ------ - ----- Contractor's Name----------5)--- �__ --- ------------- -- ------------ -- -------------------------------- ------ Phone----------------------------------- Installation will serve: Residence Ik Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __!____ Number of bedrooms ____1__ Number of baths J____ Lot size _______ ________________________ Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table lq__ ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes E] No New Construction: Ys No E] FHA/VA: Yes F] No pr TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public s war is availab hin 200 feet.) Septic Tank: Distance from nearest well___ASO__-Distance from found n__ _/_b_-__ __.M t - I_C ✓T� � �______ ____. No. of compartments Liquid de .t----- Ca acitY -lac----------------- Disposal Field: Distance from nearestwel __4_0_ _-Distance from foundation_J_Q_--------.Distance to nearest lot_ Ij1r e___S-______ Number of lines_______1__._____-______.____ Length of each line___-�0--------------.Width of trench__Of__.___ _.. Type of filter material_ T71 --Depth of filter material_____�R _____._Total length--,50______ Seepage Pit: Distance to nearest well_____________________Distance from foundation--------------------Distance to nearest lot ---- ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation------------------- Lining material-------------------------___-_____. ❑ Size: Diameter--------------------------------------Depth----------- -----------------------------Liqui.d 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 .r..e�guulations of the San Joaquin Local Health District. (Signed) �- -'-trGr, -----------------------------------------------------------------------------------------------------(Owner and/or Contractor) BY: A. -------------------------------------------------------------------(Title)--------------------------------------------------------------- (Plot plan, showing size of lot loca iio of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY--------------------------------------------------------- ---------------------------------------- DATE-------------------------------- REVIEWED BY---------------------------------- ---------- DATE----- ------ - - -------------------- �_ � --------------------- __________________________ ______________ _ _ _ i _ _ _ ---------- -------------- BUILDING PERMIT ISSUED ---------------- - - -- - - DATE ---- -- ----- --- ------- -- Alterations and/or recommendations:_______________________�___ ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•-------------------------- ---------------------------------•--------------------------------------------------------------------------------------------------------------------------------------------I---------------------------------------------- ----------- ------------------------------------------------------------------------------------------------------------- •-•--------------------•-----------•---------------•---•-------•-----•----------------------- -------------- FINAL INSPECTION BY---------------- ---- ----------- -'R +___-- -Date-------------------- ZZ—(a/ FINAL JOAQUIN LOCAL HEALTH DISTRICT 13R 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 , Revises 1.57 F,P.CO. r