6930 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. ...... (Complete in Duplicate) ii fS-5" oica4iicl � Date IssuedAprs herr y n•made to the San Joaquin Local Health District fora permit to construct and install the work herein described. This application is made in compliance with County OrdinaA ce No 549 JOB ADDRESS AND OCA ION- 4 ------ -------- , Y •--------i--------- ------ Owner's Name...... . ..--------•-----------------=-- Phone ; Address----��... If Contractor's Name. �� ----•----- -•-----------------------�-•-------------_ -------------------•--•--••--•- on - ----._ Ph ��&• ) _ a Installation will serve: Residence partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other �I Number of living units: __/___ Number of bedrooms __ ._ Number of baths __!-___ Lot sizerd-----?(___�___f__ __�___________________ Water Supply: Public system ommunity system ❑ Private ❑ Depth to Water Table,;.. ft. j Character of soil to a depth of 3 fee+: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay.Loam ❑ Clay ❑ Adobe ar pan ❑ Previous Application Made: Yes ❑ No -C-onstruction: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 fee+.) y Septic Tank: Distance from nearest well[ -__Distance from foundation---I�___-.____.Material... ---------------- 4_ - No. of compartments------2- __ _ dep�h ---�___x__ __•___Li Liquid de Y G P. � 3.. ---- Capacity-- -- -j----------•- II _ { Disposal Field: Distance from nearest well !D�► .._Distance from found __ ation -f_/..._..Distance to nearest lo} line.->� -�...- -1 Number of lines_._-_-___._. _ _Leng}h of each line____.2 ''_...............Width of trench-_ _" __..____._.____..__ 0 rr �� Type of filter material--l.._0--_.._____.__Depth of filter material------/ _..Total length---- Seepage en th___Seepage Pit: Distance to nearest ---Distance from foundation__ _ ---- Distance to nearest lot lin'le__- '__�__. bif .,_ Number of pits------I-------- -----Lining ----Size: Diameter-23----_._... _ -__ Z _ Depth- �-�--'------------------ ,. Cesspool: Distance from nearest well-----------------Distance from foundation-------.------------Lining material-----------------ll------------------- ❑ Size: Diameter--------------------------- ----------Depth---------------------------------------------------Liquid Capacity---------------II------------gals. Privy: Distance from nearest well-___._.____________________._____..__----------Distance from nearest building.__._._________.______�_______.--------._. ( • ❑ Distance to nearest lot lire- ----------------------------- -----------------•------------------•-- ----•--------------------------------------------I ------------------ Remodelingand/or repairing (describe):--------------------------------- ---------------------------------------------------------------------------------------------- II--------------__ 0 ---------------------------.....-•---•---------•------------•---------•----•---------• -----------------------------------.----------------------------------------•- -------------..,__.I.,----------------------------- -1 ------------------•--- -------------------------------------------------------------------------------.------------------------...----------------............I------------------------------------------IC------ --------- Z , ----------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------- I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rule and regulations of the San Joaquin Local Health District. f Signed --------------------- ---------------------••------------------------------------- (8enrer-�endfor Contractor) --.. ..._.. -- BY• __14�5----°�e -""-'�'-�'=-----------------------------------------------------(Ti+le)--------------------------- ------ -------------------(Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). Ir � FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- - ----- ------------ --------- -- -------- ------------------------------ DATE----------------•• , ---------- ----•---------------------------- DATE---f REVIEWED BY_ BUILDINGPERMIT ISSUED------------------------------------------------- ---------------------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations----------------- - ------------- -------•---•--•--------------------------------- -•---------•------------ I ---------------- -----------•------------------------------•----------•--------- -------------------------- ---------------------------------------- ------------------•--------------------------------------------------•------- �� ----------------- ----------------------------•--------•---------------•------------------- ------------------------••------------------------------------._. ..------------•----•--... -•---. ------------------------------- --------------------- ---------•--------------------------- --------------------------------------- ------------------------------------------------- ----------------------------------- ;2 - FINALINSPECTION BY----------- ---- -------- Date. ------------------------ ----------------- - -I------------ ------- SAN JOAQUIN LOCAL HEALTH DISTRICT II 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C' Street Stockton, California Lodi, California Manteca, California Tracy, Califoiinia I E5-9-2M 145!146 AYWOOO $12-59 I II