17281 - Laserfiche WebLink

Home Browse Search

S- _. -------- - --- --------- ------------------------------------------------ -------- APPLICATION FOR SANITATION PERMIT Permit No. .-� ------------------------------------------:-------------- (Complete in Duplicate) This Permit Expires 1 Year From bate Issued Date ,issued Application is hereby made to the San Joaquin Local Heal+h District for a permit to construct and ins}all t e w eiTdeserbed. This application is made in compliance wi h County Ordinance No, 549. _ JOB ADDRESS A LOCATIO / Owner's We --- ----------- Address.. Contractor's Name- , ti , s� ---- - � L.�_ 1 Phone--------------� Installation will serve: Residence rtment House ElCommercial's] , Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __/.--- Number of bedrooms _, 'Number of baths /---- Lot size --- ----- ----- -- ---•- ' ---------------- ater Supply: Public system ❑ Community system ❑ Private ep+h,to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand E] Gravel E❑ Sandy Loam Clay Loam [3Clay Ej Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date.--...---------------) No ❑ New Construction: Yes El NoI=HA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: A . (No se is tank or cesspool permitted if public sewer is available within 200 feet.) ` nk: Distance from nearest well-----------------Distance from foundation-------------------MaterialC No. of compartmentse ---------------------- C_* ------- ---------------- - - --- iquid depth----------------/ ` Capacity +'po ill Distance from neare t wel]WO---____:Distance from foundation__ �l --__-..-.__Distance to nearest lot line_.��__ Number of lines----_. _" - __qgd Length of each line ___ �i� Width of +rench Type of filter materia ' _ Depth of filter material___j__ .--�r Total length e+ -------------•----- • Seepage Pit: Distance to nearest well-----------------------Distance from foundation---.-.--------------Distance to nearest lot line--.---_--------_ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter------------- --------Depth--------- ------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------------------------------❑ Size: Diameter---------------------------- ---------Depth---------------------------- ---- Liquid Capacity .gals. 41 Privy: Distance from nearest.well----------------------------------------------- -_Distance from nearest building A ❑ Distance to nearest._lot line----------------------------------------- ------------ Remodeling and/or repairing (describe):---_----.-_--- ------------------------------•-----•------------------------------- --- --------------------- --------------------------•-------------------------- n - _X�__ _�_ --------------------------- ---------------------- ----------•---------•- -------- -- ----------- ------------------ lei ----------------- 4, ------------A ---------------�2------------ --------------------- ---- -------------•----------•----------- --- ----------- ------I --- ------------ ere y certify that I have prepared this application and that the work wi--t be done in accordance with San Joaquin County ordinances, tate la s, and rules and regulations of the San Joaquin Local Health District. (Signed)- b c�T1 ------- ----- ----------------- ------ 5wlt6Z - Contractor) By:------------------------ (Title) (Plot plan, showing size of lot; location of.system in rete ' n�to wells, buildin , e}--- can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----__________------------------------ .-" ----------------------------------- DATE--- --- REVIEWED BY------------------------------------------------------------------- ----.- DATE------- --------------------------------------- - -------------------------- BUILDING PERMIT ISSUED-------------------'---------- - --- - --------—-----------------_ ------------------. DA•TE. Alterations and/or recommendations:___----- ----------- -------------- ----------------------- -----------------------------------------•--•---------------•---------------------------••-------------------------- --------------------------------------- ----------------------------------------- ------------------------------ FINAL INSPECTION BY:" = ---------- ------- Date. ----- � � SAN JOAQUIN LOCAL. HEALTH DISTRICT 1601 E.11a:ellen Ave, 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED B-59 3m 3•'63 F.P.q D,