6480 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued ---- r' Appliceion is hereby made to the San Joaquin Local Health District for a permit to construct and 'nstall the work herein described. This application is made in compliance with County Ordina e N 49. JOB ADDRESS AND LOC ION-------�4i✓ .. -.-- ----- o_________•--------_-_ Owner's Name------------------------------- -------------------`i1--- ,`" ---------------------------------- Phone__AT --- Address. =-1---a2 • sQ= -t�.---- -------- ----------------------------------------- ---- ---- -------- Contractor's Name-------------------------------------------- ----mit --��s ----- ----------------- ------- Phone._. 7.._ 4� Installation will serve: Residence 0--'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___t____ Number of bedrooms .__.'Number of baths _!____ Lot size _i_�t_. _�. __ ____________________ Water Supply: Public system �ommunity system ❑ Private ❑ Depth to Water Table = Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[Er-_F�ardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes -<o ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: _ (No septic tank or cesspool,permitted if public sewer is available within 200 feet.) Septic/T�nk: Distance from nearest well____ ..__Dist pm u dation__.!- Q_........Mate ial-----------------------------_______.._____ ____. l l� No. of compartments--------------------- SizX__ _____ _ ------Liquid depth___ _'e...........Capacity J� j pisposal Field:, Distance from nearest well7�.-_____Distance f om fotion___ r:_.Distance to nearest lot line__ _.�Y__' [� Number of lines----- Length of each line-_25-0 _ Width of trench-x_54"----------------- - r .�. -FC y r j_._. Type of filter material-_/___/ Depth of filter material______ ( __.____Total length______________..__._ `?f ) _ Seepage Pit- Distance to nearest well-,�Q©---__----Distance o,m��foundation_..�.�_..Dsstance to nearest lot line_4_.__�__ Number of pits...----------------Lining material_ Uj________-Size: Diameter__ 33--_-___-__..Depth.-- 7--------------- Cesspool: ----- _-__-Cesspool: Distance from nearest well-----------------Distance from foundation---------------------Lining material-------------------------------------- ❑ Size: Diameter--------------------------------------Depth------------------------------------------------ -Ligwd Capacityals. Privy: Distance from nearest well___._______________________---------------------Distance from nearest building -- -------- ---- ❑ - Distance fo nearest lot line--- - - --------------------------------------------------------•----- ------ --------------------------------------- Remodeling and/or repairing (describe) --- --------------- ----------------------------------------------------- ----- -----------------•----------------•------------------------•-•--------•-------•-----------•------•---•------------------------------••------------------------------------------------- 1 --------------------------------------------------------------------•----------------------------------------------•---- ------------------------------------------•--------------------------------------------- I. I hereby er+ify I have prepay his applicatio nd that the work will be done in accordance with San Joaquin County, ordinances, State l l s, a rules a d r- tions of t San Joaquin Local Health District. `sf (Signed)------------- --- ---- --- ----------- -� -�(9�/W_Contractor --- - -------------------- ----- ------ - -- I B ---(Title) --- �----------t' ---------------- � (Plot plan, showing size of lot, location of system in?1af4on wells, bu;dings, etc., can be-'placed on reverse side). 7 FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY-------------------------- - - ---------------------------------------------------------- DATE------ _�_�_------------------------------ •--- --- REVIEWEDBY------------------------------------ ----------------- - --- --- ------------------------------------------------------ DATE------- --------------------------------------------- BLtILbING PERMIT ISSUED --------------------------------------- -•-------•---- DATE------------- ... j. Alterations and/or recommendations:_____________________ __ _ ------- ____._____________________ ------------------------------------------ --------------------------------------------------------------------------------------------------------------- --- •�------------ ----... --------------------------------------- ------ -------------------------------------------------------------------------------------------------------------------------------------•-------------------- ------ FINAL INSPECTION BY:.--- ------------------------------------- Date---- ------- -r--------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Sfreet 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy,-California ES-9-2M ; Revised W-2100 I