7019 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. ___-.l_ ----.- .. [Complete in Duplicate] �lP Date Issued .__`__ ._.._7Ar Application is hereby made to the San Joaquin Local Health District for a permit to construct and install fhe work herein described. This application is made in complianc=;V anc N 549. _ a/ T JOB ADDRESS A,=LOCAT�N .G - � --------------•---------------- Owner's N `e--- __.._ - - -------------------------------------- ------------------------ Phone-. -'Address"-k,.1---------- r - -- -- ----------- Contractor's ---------Contractor's Name------------: ----- --(-�------ -------------------------------------- - ---------------------------- -----------------------•-----•------- Phone----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _�_/___ umber of bedrooms _:!!._ Number of baths A____ Lot size _-. j __ 1 l - -_ _._ ------------- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table _ _.-_, ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑z Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No)� New Construction: Yes ❑ No , TYPE OF INSTALLATION AND SPECIFICATIONS: R' (No septic-fank or cesspool permitted if pu sewer is available within 200 feet.) Septic❑ Tank: tante from nearest well__. ---_.0-__Distance from foundation-_�-. .__._.Material------___________________________...___..._____. o. of com artments--------------- --------Size------------.------. --Liquid depth----------. -- --Capacity a / Disposal Field: istance from nearest well_( ..._Distance from founds ion_____ox_L�Distance to nearest lot li ------ ❑ ��J _ Length of each line_ �l Number of lines__---�+� _0_�-___ .__5'._-Widfh of trench.__s�_-___ _.___________ G �4. 7�Depth of filter material_____ ._ .1�____.Total length_____' ___ Type of filter matenal_S�_ _ _. X Aj Seepage Pit: Distance to nearest well------------__ ------Distance from foundation---------------.___.Distance to nearest to line__.._..__________ ❑ Number of pits-----_--------------Lining material------------------------Size: Diameter-----------------------Depth--------------------------------- , Cesspool: Distance from nearest well----------------- from foundation--------------------Lining material___....-__________.____----_________. ❑ Size: Diameter : ,ate DePjl? T ----- - ._ :: ' ,-----Liquid Capacity_ _gals. i Privy: Distance from nearest well--------------------------------'-----------------Distance from nearest building ❑ Distance to nearest lot line____-'_____.___-�`_"•`�.. ' Remodeling and/or repairing (describe--------- - ---------- -----------------------------------------------•----------.._.------------•----••--•----... --- ---------------------- 110 •----------------------------------------------------------- ---------------•----...-------------------------------•---•----------------------••---•----•---------•--------•------ •-----•--•------------------------------- -----------------------------------'-k--------------------------------------------------••------------------------------------- ------- ---------- r 1 hereby certify that I have prepared Phis application and that-the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. , (Signed-50 -- f� ----- ------------------ ------{Owner and/or Contractor] By: ---------------------------------------------- -----------------------------.-------------------------(Title)------------------------------------------------------------ (Plot plan,'showing'size of lot,ocati lon of system in relation to wells, buildings, etc., can be placed on reverse side). s FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- --- --------------------------------------------- ------ DATE-•---------------------- REVIEWED BY----------------------------------------------------- --------- . DATE----- j�.- BUILDING PERMIT ISSUED...._.... ---------- DATE-------------------------------------- - ----------------------------------------- Alterations and/or recommendations:_-------------- -----------------------•----•--- •------------------------------------------------------------- ----------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------- -----------------•----------------------------------------------- ------------- ------------....--------------------------------------------------------------------------------------------------- -------------------------------------------- ... •---•---------------------------------------------- ----------- ------ FINAL INSPECTION BY: = Date--------- v ---------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Sfreet 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California Er;�ZM 145446 ATwoo❑ 12-54