3992 - Laserfiche WebLink

Home Browse Search

e APPLICATION FOR SANITATION PERMIT Permit No., .__ ._ (Complete in Duplicate) `` Date Issue ds�a 0 s3 Application is hereby made to the San Joaqu'4W Local Health District for a permit to construct and install the work herein de ribed. . This application is made in compliance with County Ordina e No. 549. JOB ADDRESS AND LOC TIOJlN: ---------------------------------------------------------------------------------------------------------------------- Owner's Name---- •----------- ----•- �© Pone ---•-•--•-----------•--•---- ----•------•---------------• •---------- ------------------------------- --- --- ------ ---- Contractor's Name_________________________ ' - -;• --•- -- ----------------•------ ------------ Phone-- .��__'°��_�7•✓___. ------------------------------------- - Installation will serve: Residence / Apartment House ❑ Commercial ❑ Trailer Court E] Motel [I _Other ❑ ` Number of living units: ___ Number of bedrooms 99t.- Number of baths ----/-- Lot size ---------------------- ater Supply: Public systemCommunity system E] Private [IDepth to Water Table ?aft. Character of so;] to a depth of Ket: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe/ Hardpan E]Previous Application Made: Yes ❑ No New Construction: Yes p No TYPE OF INSTALLATION AND SPECIFIC TIONS: 4Qi 'a (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well________________Distance from foundation_-____________-____. Materia-_No. of compartments-- ---- - ---- ---- ----Size__.------------- -----------•___Liquid depth---------- --------------Capacity -- epacitY ------- ---------------- Disposal ------ -- ---------------- Disposal FielclF Distance,from nearest well 15040------Distance from foundation------ '...Distance to nearest lot line__. r.___. IX Number of lines______--/---_-._-----I-----Length of each line__-�------------__Width of trench___/- T e of filter material J e( - ----------------- Yp ---- ------Depth of filter material----7- __-- - -----Total length-------�_k f------ Seepage Pit: Distance to nearest well----------------------Distance from foundation---.----------------.Distance to nearest lot linef____ ❑ Number of.pits----------------------Lining material----------------------- Size: Diameter ------ .....Depth-------------------------------- Cesspool: Distance from nearest well_________________Distance from foundation-__-_--~__---- - '"r - --- .Lining materia)--------------------- ---------- -- Size: Diameter- ---------------------------------Depth----------------------------------- Liquid Capacity :---------- ---------gals I Privy: Distance from nearest well------------------------------------------------Distance from nearest buildingEl 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 and le nd regular' of the San Joaquin Local Health District, (Signed)_ ' ------------------------------------- By:-----------••-----••------------- ••- -..---• •--- -�----•- - (Title)., ._ caner an or Contractor) (Pl ------------ -- -------- __ of plan, showing size of lot, cation of system in relation to wells, buildings, --------- - ------------ etc., can be cad on reverse si FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY__ ' DATE -__ REVIEWED E I IS U 5- ---- DATE-- ----------------- --- BUILDING PERMIT ISSUED___________ ------------------------------------------------------------ DATE--------' Alterations and/or recommendations:-_-_________ _____--_- ----------- ----1/ -----------------------------------:---------------------------------------•-- ----- ----------- --------- FINAL INSPECTION BY--------------------------------- - � f) Date------------ -- - ------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street $14 Norah "C" Street Stockton, California Lodi, California Manteca, California • _Tracy, California ES=9=2M 10-52 Revised W-MD J