8389 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) r 1 ! Date Issued Applica+ion is hereby made to the San Joaquin Local Health District for a�ri This application is made in compliance with County Ordinance No. 549. P "`� fi fo construct and install the work herein described. JOB ADDRESS AND LOCATION_..______ •�'_' ------•--------- ---- ----------------- -- Owner's Name --- Phone. ---•---"---- --------------------------- Address__.....-•---•------.-----•-- ------------------------------- Contractor's Name ---------------- ---•- ---------------------------------------- _ ------------ Phone -------------------- Installation will serve: Residence X Apartment House 0 Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: L Number of bedrooms �` Number of baths I___ Lot size __.------- _-�/ !�` Water Supply: Public system ❑ - Community system ❑ Private;K Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No,N�,New Construction: Yes ❑ No - TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Sept Tan Distance from nearest well-_ ______________ Distance from foundation -------------- ..___.Material ------------------ .__.___...___.__ i No. of compartments- ------------ ---------- Size_-'----------------------------- Liquid depth ---------------"--- - - - -CapacitY"_=- p--------,•----------- Dis osal Field: Distance from nearest welf__-�"------ Distance from foundation__-._ �]._.___...Distance to nearest lot line:--- ...... Num oT lines ---------------z--- -----_----- Length of each line ------- Width of trench-------------` j Type of'fiiter material______ _ ------ Depth Depth of filter maferial-_.._---------_Total length --------------- zU_-_ Seepage Pit: Distance to nearest well_____________________Distance from foundation__,.. ----- .-------- .Distance to nearest lot line_ ___.____._._. ❑ Number of pits--- ------------------ Lining material-------------------- -.Size: Diameter Depth-------- Cess❑ooL Distance ameter_nearest well-----------------pDesot{Ince from foundation -------------�,T__ Lining material__------ ---------- ------------------- Size:Q p ---Liquid CapacitY-. •-----------------------gals. Priv D'isfance from nearest well_.-:_____"----_------------------____-- Distance from nearest building 1 ' y'- i ❑ _ Distance to nearest lot line ------------------- ---- A� r . Remodeling and/or repairing (describe)_____________________ __ -- ---------------------------•----•-- r —,.----------------- ' i . . I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Coun�, k ordinances, State laws, and ,rules and regulations of the San Joaquin Local Health District, (Signed}-rfi2-• ---� -------.-------------------------------------- ------(Owner and/or Contractor) By: --------------,`---------------------------------------------- (Title) (Plot plan, showing sire of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY I, APPLICATIONEDBY ACCEPTED BY_________________ DATE_._.__--_ ,_- _ --- --- _ - - - - IEWG E -- --------------------------- - - - - -- ------------------- ---------------- DATE------"-- -------•_..._... � � �----- - ----------------------------- BUILDING PERMIT ISSUED. ----- ------- ---------------------------------------------------------------•-- DATE. - -- Alterations and/or recommendations: ------- _------------------ ---------------- ---- r =------------------------------ -------------------•------•--- .. -S"� r ---rte-• FINAL INSPECTION BY:__ !,_ �•-- -- r- �� Date.... -:-3 x ---------------------------------------- SAN ------------------------------------ -SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street Stockton, California Lodi, California Manteca, California E!3-9 ,as<as ATWOOD 814 North "C" Str Tracy, California