7797 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit. No. ...... (Complete in Duplicate) Date Issued Applica}ion i�' hereby made to the San Joaquin Local Health District for a permit to co ruct an in all the wor�h�ein described. This application is made in compliance wit Count Ordinance No. 549. '� " f (� JOB ADDRESS AND LOCATION--------- --'`-------------- �" -�-_• _!-•----. ---------... + ,�� --f.� 1 [ :wC------------ -------------- Phone` ' ----------------- Address ----- .----- f - , (� ---- --------•--------- --- Contractor's Name.--_. - ------------ ---------------------•--------------------- ----------------•--- Phone__ ?.- --�f + Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __I___ Number of bedrooms .Z-- Number of baths _�---- Lot size -------V4------&&k-�J------------------------- Water Supply: Public system ❑ Community system ❑ Private Q(Depth Water Table 3P. ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ \, . Previous Application Made: Yes ❑ No New Construction: Yes No [_1 �] TYPE OF INSTALLATION AND SPECIFICATIONS: , (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r , - �'y"t' ------- Septic nk: Distance from nearest well-00._____-_DistaLn��e from foundation------ _ ._ _ . . No. of compartments--------------------------Size_- _ -.St* --- -----Liquid depth____._-S�._------Capacity__- Disposal Field: Distance from nearest well-,-I"C3-_._____Distance from foundation___Z ......Distance to nearest lot line __.i_____._____- Number of lines-------1--------------------------Length of each line-----U?--------.------.Width of trench------ - -1-1 Type of filter materiai__�----------Depth of filter material____1.2---_._.___Total length____.__!_9%4----------------------- Seepage Pit: Distance to nearest well----------------------Distance from foundation---------------_---Distance to nearest lot line----------------- El Number of pits----------------------Lining material------.----------------Size: Diameter----------------------.Depth-------------------_-----------.- Cesspool: Distance from nearest well-----___________Distance from foundation----_.__.___.__.___Lining material------------------------------------- ❑ Size: Diameter - --------- --------- ----------Depth-------.. ..-------------•- --------- ------Liquid Capacity--------------= -------gals— _ . —. ._ Privy: Distance from nearest well------------------------------------------------Distance from nearest building.----._------------_---------------------- ❑ Distance to nearest lot line------------------------ -----•---------------------------------•- -------------------------------------------------- Re *odelin and r re airin describe ______________ B'-------- ---------- ---- ---------- �] - --W4 -- ----•-------- - - ---i ---------- ----------- --•---- �� ----eS,. ------ ! --- --- ------------- ----•-----------_-•--- �.------ I hereby certify that I ave prepared this application and that the work will be done in accordance with San Joaquin oun ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. ______(Owner and/or Contrac j '(Signed)--- --------------------------------------------------�1 I . Title By:_------- -- - ------------------------------------- ---------------------------------------------------------( )--.- --- - (Plo# plan, showing s e of lot, cation of system in relation-to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY- f I APPLICATION ACCEPTED BY___.-___ DATE________________ ------------------ REVIEWEDBY---------------------------------- lrc�-- ----------------------- -------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED_------------ ------()-----------------------------------•------ ------------------- ------ DATE----- -•---------------------------------------------------- Alterations and/or recommendations----------- ---------------- --------------------------•---------------------•-------------------•---•------•--•-----------------••-------------------------- ----------------------------------------------------------------------------------------------------- ---------•-1------------------------------------------------------------ ----...----------------------------------------- ---------- - -- ------------------------------------------------------------------------------- ----�------------------------------------------------------------------------------------------------------------------ �r ------------ --------------------- ------------------------------------------------------------ ------- Date-- FINAL INSPECTION BY------*��, --------AN 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 745446 ATWOOP 42-54