4548 - Laserfiche WebLink

Home Browse Search

1�y APPLICATION FOR SANITATION PERMIT Permit No. . --_-- `� (Complete in Duplicate) •7CANNG++�a/�p� CC r� p Dite 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 LOCATION.----------- — { ------------------ --------------------------------------------- Owner's Name--------------- ,�^ •-----------------------•"-- --- -�=-•- ---'---- - � - - - --�=-�":�-�------------ - ------ Phone.--o1 --- - - ---=/lap---------- ' Address �1 --- - ------------ Contractor's Name--------- ---------------- ---------------- .-- Phone--- Installation hone--Installation will serve: Residence X Apartment House ❑ Commercial ❑ Trailer Court p Motel ❑ Other ❑ Number of living units: -.1------ Number of bedrooms --Y Number of baths -`---_ Lot size ------:-.:/F -__"--- Water Supply: Public system ❑ Community system ❑ Private j' Depth to Water Table -------- ft. Character of soil to a depth of 3 feet:' Sand.❑ Gravel ❑ Sandy-Loam ❑" Clay Loam ❑ Clay E] Adobe ' Hardpan ❑ ' Previous Application Made: Yeses-❑ No,& New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION.-AND SPECIFICATIONS: ,1~ (No septic fankfor cesspool permitted if public sewer is available within 200 feet.) tic Taak: ` .. Distance from nearest well-------.----- Distance from foundation-------------------Material__---- No. of compartments--------------------------Size-----"--------- Liquid depth Capacity osa! i (Distance from neares# well Distance from foundati f ��'_".-..Distance to nearest lot line--- . '� i f^^�T Number of lines----_------- f--_,f_ Length of each line---- 0- --- ff �ff _ Width of trench__ ------------------ Type of filter material."T ---LGl - Depth of filter material---.- "� ``-- Total length-_--R� ------------------ 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------- f ❑ Size: Diameter--------------------------------- ----Depth----------------------------- ---------- ----------Liquid Capacity--- ------------------------------ -----------------------gels. Privy: Distance from nearest well-------------------------------------- ----_-Distance from nearest buildin 9 ❑ Distance to nearest lot hne Remodeling and/or repairing (describe)------------------ ------------•- -------------•------•"-------------------------------------------------------------•-------------------•------ ----------------------- -- --------------------------------- __ _ Y y pre d thisjappcation and that the work will be done in accordance with San JoaquinCountyI hereb cert that I aveordinances, S ate I ws, an Wes and r gulatith an Joaquin Local ealth District. v 4) ---- -- -- -- --- - �r --.. - --------- - -------•--- ---- ----------------------------------- ---�-taG�Yx� act By------- -------------•-----------------•------------ --- - (Title) Contractor) -- - -- ------------- --------------- FOR _ _________ (Plot plan, showing size of lot, location of system in rela on to wells, buildings, etc., can be pla a on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---------- -------- ---- --------------------- - ---- - ------------------------ -- -------- DATE---------------------- - ---- --- DATE REVIEWED BY ,/� BUILDING PERMIT ISSUED-----•"__--- ------•- -------------- DATE -------------------_---- Alterations and/or recommendations--------------- ---------------------------------------------------------- i ---------------------------- - -------•---- - ------------------------ A�� FINAL INSPECTION BY:.- 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 I E5-9-2M I4 5� Revised W-2100 I i