6533 - Laserfiche WebLink

Home Browse Search

Permit No. ..(4'J�3>,.. APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) / Date Issued ___ Applica+ion 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 ADDRES D L ATIQN----- r --- ---� ------------------•-• ---•-----....------•--- ------ Owner's Na a 1---------r--- -- - --- ---- ---------------•-------------------------------------------------------------------------- Phone Address-----------------•-•----•----- twl_GIL �-----------------•--•----------------------------------------------------•--------------------------------------------------------•--•------------- t Contractor's Name--------------------------------•- ------------•-------------------------------------------------------------------------------------------- Phone------------------------------- Installation will serve. Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other� / �•y�/ oe Number of living units: _. umber of bedrooms _2--. Number of baths ..1._... Lot size -----�__!.__._____X.............•-__--------------- 1 Water Supply: Public system Xommunity system ❑ Private ❑ Depth to Water Table ........ ft. Character of soil to a depth of 3 feet: Sand Gravel E] Sandy Loam E] Clay L am [-] Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No ew Construction: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: [No septic tank or cesspool permitted if public sewer is available within 200 feet.) 21 t' Distance from nearest well-----------------Distance from foundation--------------------Material-------------------------_------------------- No. -___-_-__No. of compartments---- ---- .------Size----------•----- -----Liquid depth---------- ---------Capacity---------- Dispos Biel Distance from nearest well- ance from foundation..:..__/0. .Distance to nearest lot lin -___• ___... Number of lines......----------�_-_--_-_--_--.__ en of each line_......._-� _....__..Width of trench- N !! Type of filter material...,}•-_141 pth of filter material__._.._.`__-_----Total length.......................................... /Taepafgefit: Distance to nearest well----------------------.Distance from foundation....................Distance to nearest lot line----.-_--_-____- Number of pits----------------------Lining material----------------------.Size: Diameter------------------------Depth--------------------------------- Cesspool: -___.-_-_----__--_._.-_._-_.-_Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- El ---- --- -------------------------❑ Size: Diameter- ----Depth---------------------------------------------------Liuid Capacity--------------------------gals. Privy: Distance from nearest well----------.--------------------------------------Distance from nearest building---.-------------------------------------- F-1 _-___-_-_--_-__•_-__._-__.- _--.-.❑ Distance to nearest lot line.--------- ------------------------------------------- ----------------------------------------------------•---------------- Remodeling and/or repairing (describe):---------.-----------------------------------------. ---------------------------------------•---•-----•--•-------•------------•------------•--•--------------•---------------------------------------•----------------•--•-------•---------..................................... ----------------------------------------------------------------------------•---------------------------------------------------------------------------------- --------------------------------------------------------- ----------------------------------------------------------------------------------------------•---------------------------------------------------- ---------- 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 rules and regulations of Oe Sad, Joaquin Lo I Health District. A -- !' t .: -•---- ��• ---------------------------(Owner and/or Contractor) (Signed)----- - ---------------------- By:................................................................................................................................---(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 APPLICATION ACCEPTED BY---------- DATE. REVIEWED BY DATE----- = ------------------------------ ------------------------------------------------------------------------ - --------------- /� - . BUILDING PERMIT ISSUED--------------------------------------------------------------—...................................... DATE------------------------- '., - Alterationsand/or recommendations:-----------------------------------------•-------------...---------...-------------•----------.....------------..............-----------------•-•---------- -------------------------------•---- ---------•-------------------------•-----------------.....-----------------•-----•------------------. ---------------•.............................................................. .............................................................................................................................................................................................................................. ------------------------------------------------------•-------------------------------------------------------------;--•--...----------------------•--------------------------------------- --- ----------------------------------- -------------------------- ------- -------------------------------------------------------------------------------------•----------...........f FINAL INSPECTION BY: - -! ------------------------------------- Date �. !"f"---�5._----------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West,Oak Street 132 Sycamore Street 814 North "C' Street Stockton, Califomia Lodi, California - Manteca, California Tracy, California d ES-9-2M Revised W-2100