6258 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit-No. (Complete in Duplicate) e 4' y Do- ed ___r�--_ Applica4,ion 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 Ordinance No. 549. JOB ADDRESS AND .LOCATIO Owner's Name------------ -------------•- ti f Phone I� -- ---- ----------------------- 1 _ Address----------------------------------------------------= - Contractor's Name--------------- ---,--------------------------------------------------,------------ Phone I� ..... Installation will serve: ResidenceApartment House ❑ Commercial ❑ Trailer Court ❑ Motel l Other E❑ J Number of living units: /----- Number of bedrooms __ �Jumber of baths ._ __ Lot size ____-- S`-=._9.. Water Supply: 'Publicskstem ❑ Community system ❑ Private\V§-.,Depth to Water Table -------- ft. !� Character of soil to a depth of 3 fee+: .Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No-g New Construction: Ye� No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if Public sewer is available within 200 feet.) , f. . -71 Septic Tank: Distance from nearest well__ _. __--__Distance ro nd f n__l_ _ ..____.Mae ' I__" - No. of compartments-.--.-.---?..----- ---- - Size----1:T_/—_-,1X-- - ' Liquid pt _ _--�:- --------CapiacitY__-- ----- --- _ \' Disposal Field: Distance from nearest we€!__-4' Distance from foundation----- -- .._ Di tante to nearest lot line__-- t Number of lines___.__'__________ ___ __ _____Length of.each line----- 4 _ dth of trench__�IM_ f Type of filter materia!___._ _ Depth of filter material---- __ __________Total length________ _ r� - -----------------=---------- Seepage Pit: Distance to nearest"well_________------------ Distance from foundation---------------------Distance to nearest lot line_----_-..-_--__-- ❑ Number of pits.'_------------------Lining materia;------ --------------.Size: Diameter------------------------Depth-1M------------------------------- Cesspool: Distance from nearest well----------------- from foundation-------------------.Lining it ❑ _ - material__._:I______________________________._ Size: Diameter------------------ - ------Depth---- ---------- ---------------------------------Liquid Capacity IM' gals. z . . . Privy: Distance from.nearest well---.----'----_"________________________________Distance from nearest building-___--_-:i4_____---___-_._____--____.__ Distance `l it tonearest lot-line---------------------------------------------------------------------- -------------------------------------=��------------- Remodeling and/or repairing (describe):-------------------------------------- ----------------I-------------------------------------------------------- --------•------------------------ ------------•------•-•-----•-----------------------•-------•----•-- -•------••-------•---------------•-----------------------•---• --------------------------------------------------1M....--------------------------- --- IM 4 ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ I hereby certify that-I have prepared this application and that the work will be done in accordance with San Joaquin Coun ordinances, State la , and rules and regu ations of the Sin Joaquin Local Health District. (Signed)..--� ----��--- - -- ----� - -----------------------=--------------------------------- ,p. � _ _-___ --.--_-{Owner ant!/or Contractor) ' -- -�- -�-- - -- .�, 11 By: - --- -- - ----- {Title} , (Plot iiIan, 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- ��--'---------- - R.EVI EWED BY---------------------------------------------------- ---------------------------------------------------------------------- DATE M ---------------- BUILDING PERMIT ISSUED------------------------------------------------------------------•---•------•--••- DATE-----------------------------(M---------------------•------- Alterations and/or recommendations:----------- '--- ._----------------------------� --------.----- _-- _ -- --------- -------- ---------------- 1 2 -- -- ---- : -:I� .. --------------------11-- --------------------------------------------------------- - -- ---- --- --- --------------------- ti --- - ---•-•---- •---- �--- --- -- ----- ---- ------------------------ ------------ ------------ - -=---- ---- --- --- -- - ---- -- FI A I SPECTION BY:.- Date- =' SAN JOAQUIN LOCAL HEALTH DIST CT 130 South American Street 300 West Oak Street 132 Sycamor Street 4 North "C" Street.- Stockton, California Lodi, California Manteca, Cali rola Tracy;i California e E5---4-2M Revised W-2100