4442 - Laserfiche WebLink

Home Browse Search

i APPLICATION FOR SANITATION PERMIT Permit No.y _ _ li D i C ( omplete n Duplicate) � Date Issued I- - .�,- S � Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work her ' described. This,application is made in compliance with County Orrdinanc No. 549, J05ADDRESS AND LOC TION �r �t -------------------------------- ----------------------•------------------------------ Owner's Name----/-- ---- ---------------- ---- --------------------------------------- Phone----�.� A. Address--------- �.• ------ ----- ------ ---------------•-------------------------•------------ Contractor's Name . ---------------- -------•-------- Phone-_•� =Qle Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel, ❑ Other Number of living units: -----__ Number of bedrooms -------- Number of baths -------- Lot size -------------0.X____,/A_6------------------ Water Supply: Public,system g Community system ❑ Private ❑ Depth to Water Tabled- ft. Character of sail to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam 0 Clay ❑ Adobe ` Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes ❑ NoIr ' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----_ d_-.-Distance from foundation Di -- "-- --__-__- --------_-----.--------- po No. of compartments.-------_�-_ L q p - ---Capacity--- ----- Disposal - Dis osal Field: Distance from nearest well---,p d_--._Distance from foundation--------------------Distance to nearest lot line----------------- Number of lines------------/----- -----Length of each line-------a- ------___"_.Width of trench------r2-y-.._____--------- og--k---Depth of filter material----"1-f."---_--.Total length----------- -------------------- Type of filter material-__�•- ---- -- i Seepage Pit: Distance to nearest well-.-��.Q--__---Distance from fou dation--------------------Distance to nearest lot line____-5-----.._- Number of pits--------�-----------Lining material Size: Diameter------3-4-----------Depth--------- --------- C`esspool: Distance from nearest well-----------------Distance from foundation-----"--------------Lining material------------------------------------- ❑ Size: Diameter------------------ -------------------Depth-----------------------------------------------------Liqu;d Capacity. -------------------------•gals- Privy. Distance from nearest well------------------------------------------------- from nearesr building-------------_._----------_-----------_. ❑ Distance to nearest lot line------------- ------------------------------------------------------------------------------------------------------------------------- -- ' ----- ib ---- ib ---------- :R odel�n and or Ides --- - 14__*�_ -e i . ----------------------------------------f----- -- -- -------------------------------------------------------------------------------------------- ------------------•-- •------- --- ---------------------•---------------------------------------------------------------------------- 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; and rules and regulations of the San Joaquin Local Health District. } ( ner andContr tor) {Signed}-----------------•- ----- -------•------------ ---- -------------------- -- --- --------------- ------------------------------------------ ---- g --------- (Title)---- -- --- -------- --- --- -------------- (Plot plan. showing size of lot, location of s tem in relation to wells, buildings, etc., can.be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- DAT --N* _-- REVIEWED BY----- -------------------------- ---- ----- ------------------- -------------------- -------------------------------- DATE------ -------------------------------------------------- BUILDING PERMIT ISSUED-------- ----- DATE--------- - ------------------------•--------------------- Alterationsand/or recommendations:-----------•-------------------------------- - --------------------------------- ----------------•---•----- -----•-----------------•-•-••-------------------- ---------- -------------------------------------------------------- ---- /(/ 29 -:- FINAL INSPECTION BY--------- ----------- -- ---1-i" _/ Date.-.- 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 0-52 Revised W-21DO