2511 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit ty� v (Complete in Duplica+e)41 SCANNED 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 LOCATION---._-.-_ -_Srtr2 y�1 ------ ------------- Address----------- - 7a-4--j" - Contractor's Name - - ...... - YL:t_4 fes.-------- ------------------------------------------------------------------------ Phone --- - - Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel El Other ❑ Number of living units: -.�..-_ Number of bedrooms -1---. Number of baths -1----- Lot size ...� 2r -.-f�_141,_ -Q ---------------------- Wafer Supply: Public system Community system ❑ Private [_I Depth to Water Table -------- ft. t - Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam E] Clay Loam ❑ Clay ❑ Adobe❑ Hardpan El 'AAV Previous Application Made: Yes E] No M/- ew Construction: Yes ❑ No �� v` TYPE OF INSTALLATION AND SPECIFICATIONS: V (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_----------------._ i Disposal Field: ' Distance from nearest ell..._["'..._Distance from foundation----ID____.Distance to nearest lot I'�j-�.-..----. D6 umber of lines Q[ .... � ength of each line.--_-_�_- Width of trench , , \Y ��}} r .> Type of filter material--.�`.- -- t epth of filter material_- .- -_�� Total length..._.. 31x�, G -- "e ge 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, Privy: Distance from nearest well-----------_ ------------------- Distance from nearest building----- ---------------..------....._._. ❑ Distance to nearest lot line----------_ -------------- - - -- -- - -- Remodeling a r repairing (describe)z- t��,�[ .p �rtk_._k• r-Q!1___-- �Y Q�t{ -_. _rt e-__----- 2LL G ----------------------------------------- 1 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 rules and regulations of the San Joaquin Local Health District. (Signed) -- -- ---------------- - - - - - --- ------------------ (Owner and/or Contractor) By:- ------------------------------------ - - --- ---v ----------------------------------------------------_(Ti+le) - - - - - -- (Plot plan, showing sae 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--- --- ------------- REVIEWEDBY--------- ---------------------------------------------------- ------ --------- ------------------------------ DATE---------------------------------------------------- BUILDING PERMIT ISSUED ------------------------------------------- ---------------------- --------- DATE----- --- ----------------------- Alterations and/or recommendations: ---------------------- ----------------------------------------------------------------------------------------- -----------------------------------------------------------------------------• ----------------- --------------------------------------------------- -------------_---------------------------------------- -------- .._---------------------------------- ------------- /- -- ...._.... . - ----- ---------------------- ----------- - - FINAL INSPECTION BY:- - _ --- ----- --' ---. 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 ES-9-2M 8-51 Revised W-2100