3493 - Laserfiche WebLink

Home Browse Search

,rr APPLICATION FOR SANITATION PERMIT Permit No. _3-`t`_--7-3_ (Complete in Duplicate) Date Issued i Application is hereby made to the San Joaquin Local Health District for a permt to construct and install the work herein described. This application is made in compliance with County Ordinanc No. 549. JOB ADDRESS AND LOG TION = L F --------------------------------------------------------------------- Owner's Name---------------- �---lll��_ ---------------------------------------------•----- Phone Address------------------- ---- --- ---- - --- ----- - ---------------------- - -----------.------ - . ---------- ------ -------- Contractor's Namee .- .�' .� -- Phone +G 'q� �r Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ k Motel ❑ Other ❑ Number of living units: _____ Num -of bedrooms ___ Number of baths/-_-____ Lot size ---------- Water Supply: Public system ommunity system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ . Clay Loam ❑ Clay ❑. Adobe pan ❑ Previous Application Made: Yes ❑ No ew Construction: Yes o~5- TYPE OF INSTALLATION AND SPECIFICATIONS:. (No septic tank or cesspool permitted if public sew s available within 200 feet.) Septic Tank- , Distance from nearest we ,;-� ` istance from foundation-/�________-.Mat�ria��___ --------------_W_ (;a' No. of compartments________:_____ i. ___r -____Li u�d depth _ ___Capacity____�_`__ i q p �-----------�- p Y- ,,ma�yy Disposal Field: Distance from nearest we[i - stance from foundation_ee�+4I-- Distance to nearest lot line______ Nurinber of lines______ ____- _ ength of each Iine_�_d_C_?--._.Width of trench__�� Type of filter material ��epth of filter material _____/.',?'_Total length_______Z- ____------------ Seepage _ ____Seepage Pit: Distance to nearest well _______________------Distance from foundation--------------------Distance to nearest lot line_______________ ❑ Number of pits-----------------------Lining material-----------------------Size: Diameter------------------------Depth---_-----.----------------------- Cesspool: Distance from nearest well-----------------Distance from foundation_____________ - Lining material_.----.-------_______________________- ❑ Size. Diameter--------------------------------------Depth---------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------- from nearest building_____________________________________._. ❑ Distance to nearest lot line--------- •---------- -------------------------------- f' ----------------------------------------•--------------------- :/, Remodeling and/or repairing (describe):-------------- - ------ ------ '----------•---------------___------ ----------------------------------------------------------------------------------------- f '.. """ e ----------------------------------------------------------•-------------------------------- ------------------------------------------------------------------- -------------------------------------------------------------•----•--------- --------------------------------------------------------------- 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, nd rules an regula Vons.of the San Joaquin Local He th District. (Signed) _ *' ----( and/or ntractor) BY:---------------e-_00 = (Title) (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY = ---------------- DATE 7 /.— .. REVIEWED BY----------------------------------------------------------- ------------------------ ------------------------- - DATE------- --- /-Z----------------- ------------------------------- - BUILDING :/-Z-----------------•------------ BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE-------------------------------------------------------------- Alterationsand/or recommendations:------------------------------------- ---------------------------------------------------------------------------•--•----------------------------------------- ------------------------------------------------------------------------------------------------------------------_- ---------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------- ----------------------------------------------------------------- ---------------- ------ ---- --------------------------------------------------------------------------------- FINAL INSPECTION BY: -• ��-- ----- Date---- /bl----------------------------- ----- T SAN JOAQUIN LOCAL HEALTH DISTRICT -130 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 B-51 Revised W-2100