5509 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. _ ��_.... \ O (Complete in Duplicate) " 1 � Date Issued Appr plical-ion is hereby made to the San Joaquin Local Health District for permit to construct and install the work herein,described. This application is made in compliance with County �Ordinan o. 549. JOBADDRESS AND LOCATION---------•(:-e --- ------------ --- - ----- ....----------------------------------------------------------------------.-Q-•------------ Owner's Nam -- ---- ----------- ------------------------------------------------------ - --- Phone..... Addres - - -- ----------- ---------- ----- ----------- ----•-•••-•----------------•-••----•-------•-----•-----•••-•-• ------•••-----•-•........................... - Contractor s Name-------------------- ---- -- - --- =t---- - ---------------•------------------------------------------------- Phone..... 3, l2.- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _/-___ Number of bedrooms �, Number of baths -_/___ Lot __________________________ Water Supply: Public system K Community system ❑ Private ❑ Depth to Water Tabled ___�_Ilt. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Ado� Hardpan ❑ Previous Application Made: Yes ❑ Nox New Construction: Ye3,kr No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 6" ptic Ta Distance from nearest well_________________Distance from foundation___________________.Material__-__-_______________________________________-__- .r • No. of compartments--------------------------Size................................Liquid depth--------------------------Capacity---------------•------• 4isaposal F : Distance from nearest well-----------------Distance from foundation____________________Distance to nearest lot line................. (,�} j] Number of lines----------------------------------Length of each line------------------------------Width of trench----------------------------------- 10 Type of filter material_____________________"___Depth of filter material------------._"--------Total length______________________________________-___ Seepage P' : Distance to nearest well_ t.�t"___Distanc"m ,-o ation___,,/d........Distance to nearest lot line____,.r�.___� �,g. , Number of pits-----/--------------Lining material -Size: Diameter___.,----------Depth------- —._____ _____- r ryry ey Cesspool: Distance from nearest well_______---------Distance from foundation_____________-____"Lining material_ _._._! -/ff _'______ _ ❑ Size: Diameter--------------------------------------Depth------------------•--------------------------------_Liquid Capacit --------_--_-�{s --gal Privy: Distance from nearest well----------_--------------------------------------Distance from nearest building------------------------------------------ 171 Distance to nearest lot line------------------------------- -•------------- -----------•--------—----•--•---- -------------•---------- 01 Remodeling and/or repairing (describe):------ 1 �� •---------=- .... -- .... - •--- ---------------• - -------------------•--•---------------•-------------------------•-----------------------------••---- --------------------------------------------------------------------------------------------- -••-------------------- t -----------------------------------------------------------•----------................................ -----------------------------------------------------------------------------------•--------------------------------- ----------------------------------------------------------------------------------------------------------------------------•--------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State ws, and rules rid regulatio of the San Joaquin Local Health District. �f1 (Signed) - -----:- -- ---------`----------------------------------------------------------------------------- -(Owner a d Contractor) By:................................ -- -------------- ---- ---4---------------------------------------------------------------(Title - ---------- - -------- -------------- (Plot plan, showing size of lot, ocation of system in relation to wells, buildings, etc., can be d on reverse side. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------------------- ----------------------------------- DATE------------- -- -- f?) REVIEWEDBY ------------------------------------------------------------------- DATE................. ••-••-----...••-•----�-••••••------ BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE-----------------------------------------------------•-•--- Alterationsand/or recommendations--------------------------------------- -------------------------------------------------------------------------------------------------------•-•- ---•------••---------------------------------------------------------------- ----•-------------------------------------------------------------------------------•------------------------•---------------------------------- ------------------------ -----------------------------------------------------------------------------------------------------------------•-•---------------------------------------------------....-••••-•----•••••-•-••--••- ------------------------------------------------------------------------------------------------------------------------------------------------ --•---•----------••----•••-----•••-------------...---------•--•-•----••--- ---------- -- --------------------------------------------------------------------------------------------------------•---------------------------------------------- FINAL INSPECTION BY:--- V r Date... ' fi t -----------------------------------•---- 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 Revised W-2100