4948 - Laserfiche WebLink

Home Browse Search

V APPLICATION FOR SANITATION PERMIT Permit No. Vibe _(Complete in Duplicate) Date IssuedApplication is hereby made to the San Joaquin Local Health District for a permit to•construct and install the work herein . This application is made in compliance with County Ordi-ante No. 549. JOB ADDRESS AND OCATION -- ---- -------------'t."�" ---------------------------------------•--- -------------•------- �. ' --- 0wner's Na n' = = }- F- - -------------- :: Phone��''. Address .... = .:. _-• ---------------------------------------------------------- .....--•.-------------- ----------------------- Contractor's Name s �� -- ------*' ---------------------------------------------------------------------------------------- Phone- Installation will serve: ResidenceX Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms._. Number of baths I----- Lot size.-----� __ -�-_.�________________ Water Supply: Public system Community system❑ Private ❑ Depth to Water Tab1.4A_ )ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made:. Yes ❑ NoX, New Construction: Yes No E] TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool pernhitted if public sewer is available within 200 feet.) ' eptic To k: Distance from nearest well_________________Distance from foundation--------------------Material----------------__-_____-_-_________-_.________. No. of compartments--=--_--------•-----.:__Size--------------------------------Liquid depth--------------------------Capacity-----------•----------- Disposal: Distance from nearest well_________________Distance from foundation--------------------Distance to nearest lot line________.__--_ 4 Number of lines-----------------------------------Length of each line---------------------------_Width of french-----------------------------_-_--- P Type of filter material----------_--------------Depth of filter material---------------------_.-Total length----- _-__________ _-_____________________ Seepage Pit: Distance to nearest well ____Distance m fo ndation___-Z— ____-Distance to nearest lot Number of its____1_____________Linin material_ _ _ ._c_ _-Size: Diameter___-_ _ . _ De th__. ___ _ ___ p g :�1 p4.1 Cesspool: Distance from nearest well-------------_---Distance from foundation--------------.-----Lining material__-___'_-__________-______.___-__--_. ti ❑ Size: Diameter---------------------------------- p ---------------Liquid 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 I s, and r e Ad regulations of the San Joaquin Local Health District, (Signed) __________ __ _ --(Owner a d a Contractor I /�' �► By: "_ '—r--- ----•----------------------------------------------------------------------------- (Tifle�-4eid = - --- `r----- (Plot plan, showinot, location of system in relation to wells, buildings, etc., can be side). f FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY. -•---- -------------------------------------------------------•--------------------------- DATE -------------------- ---------------------------- REVIEWED BY--- ------------------------ - ---- ----- ----------------- --------------------------------------------------------- DATE 4,ft ---------------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------- DATE----•-"'~�------------------------------------------------ Alterations and/or recommendafions:------- ------------ = �' ------------------------------------------------ - f---------------- .... ----------------------- _..._.:--^ � --------1--rfJ-cl'----•-----------14- � __________.._-________________________________.__________--.___--____-__. _____.._______. -------------------------------- ----------------------•---------------------•- -•-•------------------------------------------9(bu_C/ ,.t. C------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------- ----------•--------- -------------------------------------------------------•---------------- FINAL INSPECTION BY:.--- - --- --- � ��------------------------ Date----------- --- — ------S-------------- ----------=---------------------- i SAN JOAQUIN LOCAL HEALTH DISTRICT I 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street k Stockton, California Lodi, California Manteca, California Tracy, California ES-9--•2M T-52.Revised W-2100