2303 - Laserfiche WebLink

Home Browse Search

} ' 4 APPLICATION FOR SANITATION PERMIT Permit No. :Z3 0 # t� (Complete in-Duplicate) Date Issued Application 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 LO TION -; r =--------- �-�' -------,� -- - /___ ---------------------------------------------------- Owner's Name------------__-- =- - ------------------------------------------------ Phone------ --------------------- Address.. [ .- -) ------ -----F ----- -------- --"----------- t =--- ' Contractor's Name-----� =- �`=�' " '_----- ° c f' rte Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel.❑ ther Number of living units: J___ Number of bedrooms _C5Z_ Number of b the/--__ Lot size _-_- -- _`- Lam-------------•- Water Supply: Public system 0 Community system '❑ ' Private Depth to Water Table -------- ft...- Character of soil to a depth of 3 feet: Sand E] Gravel F1 Sandy Loam E] Clay Loam E] Clay E] Adobe E_ Hardpan E] Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) s Septic Tank. Distance from nearest well---� ------Distance from foundation_, -----------Material_______- ______ _______ - ------ i o. -----No. of compartments--------------------------Size_------------ - Liquid depth--------------------------Capacity----------------------- ---------------- Disposal F Distance from nearest well-O-y-+____.Distance from foundat o6_��-+_ Distance to nearest tline__ R Number of lines____ __---- Length of each line- 4. _I Width of trench _z___-----__----- Type of filter material_. -Depth of filter material__/J7--- -----Total length-------------- ----___-_____------ Seepage Pit: Distance to nearest well---------------------- from foundation-------------------.Distance to nearest lot line---_----_.__-__-- ❑ Number,of pits---------------------Lining material_-----------------:----Sizb:,Diameter------------------ Depth--------_----------------- a Cesspool: Distance from nearest well-----------------Distance from foundation-------------- ----Lining material__-_-----_--___-____------_.-----__--. ❑ Size: Diameter.-------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well--------------------------------------------------- from nearest building------------------------------------------. ❑ Distance to nearest lot line------ -----------------------'''-----------------------------------------=----------------------------------- =------------------------- Remodeling and/or repairing (describe):-------- ^'' "_-`.----------- ° '------------------------- -------------------------- �------------------------ ---------------------------------------------------•--•------------------------------------------------------------------------------------------- -----------------•--------------------------------------------------- - ------------------------•-•------------------------------------------------------------------------------- hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State aws, and rules and regulations of the San Joa uin Local.Health District. r `'--`-'-�/_`" .--. -E .�.�.±�.� (Owner and/or ntractor) (Signed) ------ .. ... --------------------------------(Title)------- E --- "_ By: r -------j-- (Plot plan, 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 - ---------------------------------------- --- --- ------------- --- ---- -- ---- ------ REVIEWED• BY--------------------------------- - • DATE- '� W/ - r-�. --- ---- ------ ---------------------------------------- BUILDING PERMIT ISSUED-------------- - ------- ----------------- ------------- DATE------------------------------------------------------------- - and/or recommendations------------------- --------------------------------------------------------------------•------------------------------------------------------------------ ------------------------------------------------ ' -----------------------•--------------------------------------------------------------------------------------------------------------------------------------------------- -- ------------------------------ ----------------- ----------- ----------- -- --------------------------------- ------------------------ --- -- --------------------------- ----------- --------------------------------------------------------------------------------------------------------------- -- FINAL INSPECTION BY:__._ 4 '----------------------------------- 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 U-9-2M 8-51 Revised W-2100