5027 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issue Applica-lion 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 Ordinan 1 5491 L /? ' t '__� -' ' ----------f---------------------- ---------------JOB ADDRESS AND LOCATION��---•----`------f'-- /, ' _�_.,/.--_-- �. Owner s ame-- --• "- ---I, —------------------------------- Address =--- ---- ,---- - - --- ----------------•--------------------------------------------------------- , --------------- Phone, Contractor's Name--- Installation will serve: ResidenceApartment House [j Commercial E] Trailer Cour} ElMotel ❑ Qther E] Number of living units: )------ Number of bedrooms __,? Number of baths ____ Lot size __-_ --------------------- -------------------- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table � ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [IClay Loam Clay ❑ Adobe E] Hardpan ❑ Previous Application Made: Yes ❑ N0 New Construction: Ye5� No ❑ ! ` TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) / - - ✓-------� Septic Tank: Distance from nearest well--- ___Distance rVmq�4na ion__. __-Q__._-_.Material_- __ _- ,5 a No. of compartments-�----- - ----- Size - `---Liquid depth Capac�tY Q �y Disposal Field: Distance from Weare t well.��-___Distance from foundation___�C�-____.-.-Distance to nearest lot line._._.____. �+V Number of lines----�------------------�- --Length of each line--------.-rt�_!P--------Width of french------ - -------------____-- Type of filter material !4 ?--__Depth of filter material-____ _._._Total length________-, z _ ________---------- Seepage ________Seepage Pit: Distance to nearest well__AOW!----Distance from foLindation___ --------Distance to nearest lot line----__ . Number of pits- material material --------- ----- Diameter_______; ..--___"_Depth____._ ______________ Cesspool: Distance from nearest well-- ------------Distance from foundation--------------------Lining material---________._--_______._____._-__-_ ❑ Size: Diameter------ --------------------------- ---Depth----------------------------- --- ------------------Liquid Capacity-------_-----------------.gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-----------------------------------------. ❑ Distance to nearest lot Iine---------------------------------------------------------------------------------------------------------- ----------------------- Remodeling and/or repairing [describe):----------- --- ---------------------------------------- ----------------------------------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 aws, and rules and regulatio s of the San Joaquin Local Health District. (Signed .---- � f {Owner and/pr Contractor) t r, - :. By: ---------------------- -.� =---------------------------------------------------------------------------(Title) : ' �l T [Plat plan, showing size o`f hot, locati� of system in relation to wells, buildings, etc., can be ph on reverse side]. FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY-----------------------------------------------------------------y5-&------------------- DATE------------ . --------------- REVIEWEDBY-------•------------------------------------- --------------------------------------------------------------------•----------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED----- ------------------------------------------------------------------------------------------------ DATE------------------------------------------------------------- Alterationsand/or recommendations------------------------- --------------------- ------------------------------------------------------------------------------------------------------------- --------------------- -----------------------------•------------------------------------------ --------------------------------------------•-•--------•----------- --------------------------------------- -----•• - --------"-----------------------------------------------------------------------------------•--------------------------------------------- --------------"--------•------ ------------------------------------------------------------------- -----------------------------------------------•------------ ----------------------------------------------.......------------------------------------ -------------------------------------------- FINAL INSPECTION BY---------------- ------ Date------------ `s-. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stock+on, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised W-2100