2545 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. ` (Complete in Duplicate) pDate Issued Application is hereby made to the San Joaquin Local Heaith District for a permit to construct and install the work herein described. k This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION..._ -----F-6---1--7rq-I-----------------}----------------------------------- --- - ----------- _ �_ -- •Owner's Name-----------�_�.S-------�'-�-l-------�--A-X-�'.- -�'----------------------------------------------------------- Phone_ ��-a --- ------ ' Address----------------_-------------------------13 --'---------------•------------------•--•----------•----------------•---------------------------------•------------------------------------------ Contractor's Name. 1 �---- ------------- Phone .-7 9f---------- I Installation will serve: Residence Apartment Ouse ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---I--- Number of bedrooms -.Z-- Number of baths __/___ Lot size ----- ____________________________ I Water Supply: Public system ;9 Community system ❑ Private ❑ Depth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan) Previous Application Made: Yes ❑ No I New Construction: Yes X No ❑ I 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-----------------Distance from foundation--------------------Material__________________-________-_-_----____--______- ❑ No. of compartments--------------=-----------Size--------------------------------Liquid depth-------------.-------------Capacity-----------•-------- _N. Disposal Field: Distance from nearest well-----------------Distance from foundation__------------------Distance to nearest lot line________________.• ❑ Number of lines-----------------------------------Length of each line------------------------------Width of trench----------------------------------- Type of filter material_________________________Depth of filter material-----------------------Total length____-_-______________-----.______________ '0 See a O Pit: Distance to nearest well --____Distance from�foundation_____ _�-.___.Distance to nearest lot line__/_�"______ Number of pits______ -----------Lining material- _ !__ ize: Diameter-------3_19_!`__Dept h___al-t__._-_---.____- Cas oo Distance from nearest well-----------------Distance from foundation____________________Lining material-----:_________________--___._____ w Size: Diameter---------------------------------- --Depth------------------------------------------- --------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-----------------------------------------------._Distance from nearest building----------._.----------------------------- ❑ Distance to nearest lot line-------------- ---------------------------------------------------------•-•-------•----------------------------------....------------------- FRemodeling and/or repairing (describe):-------- - .A--•-------------•---------•---------------•-•--•------------------••-------- ------------------------------------------------------------------------------- --•---•------•-------------------•----------------------•--•-----------•-••-------------- 1 •---------------------•-----------------•----------------------------------------------------------------------------------•---------- ---------------------------------------------•----------------------------- ---------------------_----------------------------•------------------------------•--------------•-•----------------------------------------------------------------------------------:------•----------------- i 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 rule and regulations of the San Joaquin Local Health District. (Signed). Q--- ------- = Owner and/or Contractor) B - - ---------------------------------------------------------------•--------------------{Title)------- -.----------- (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 APPLICATIONACCEPTED BY-------- ---------- ------- ----- ------ - ---------------- - DATE----- —-------------------------------------------- REVIEWED BY- DATE- '� .�45 ----------- , � BUILDING PERMIT ISSUED-------- --- -- ------------------ I -- - ------------------------------------ --- -------------------------- ---- - DATE--------------------------------------- - ---------•-• -- Alterationsand/or recommendations---------------- ---------------------- ----------•------------------------------------•-•-------------------------------------------------------------------- --------------------•------------------------------------------------- --------------------------------- k 1 -----•---------------•---------------------------------•------------------------- ------------------------------------------------------------------------------------------------------------------------------------------ -------------------------------------------- -----------•---------------------------------------f--------- ---- ------------------------------------------------------------------------------------------------------------- ! FINAL INSPECTION BY: ----------------V--- €}ate_ 1 ------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT k 130 South American Street 300 West Oafs Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 8-51 Revisad W-2100