4045 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. .4/ Aq 2- j 0 (Complete in Duplicate) Date Issued ___ ' /. _3 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 AN Q LO TION. -- - -----,--;1----- & �-0--------- ,��- - ---------------------------- --- ----- -------------------------------------- 1 --3------------- 4 - --- --------�-----?Owner's Name -�4 ---- -------------- - Phone 4 --------- Address............!q;U,4_t0. Contractor's Name-------------6p, ------ - -------- ---------------------------------------------------------- ---------------- Phone__ ------ Installation will serve: Residence.M--'A'partment House 0 Commercial E] Trailer Court 0 Motel El Other E] Number of living units: .--1__ Number of bedrooms Number of baths I--- Lot size Water Supply: Public system F___&mmunify system E] Private E] Depth to Water Table Character of soil to a depth of 3 feet: ' Sand [] Gravel F ft. Sandy Loam E-] Clay Loam E] Clay El Adobe OXHarclpbn ❑ Previous Application Made: Yes E] No DRNew Construction: Yes 0 N TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-------------_--Distance from foundation--------------------Material El No. of compartments--------------------.....Size--------------------------------Liquid dep.th.------------- ---------- Capacity , - Disposal Field: Distance from nearest well_---..__-..---.-Distance from foundation-,----------------..Distance to nearest lot line__-_---___--__..N%. F1 Number 0. lines-----------------------------------Length of each line--------.--------------------.Width of trench--------------------------- --- r Type of filter material-------------------------Depth of filter material-----------------------Total length----------------------------------- ---- See Pit: Distance to nearest ell-.-.---------Distance fromU!olu�na+ion____,3_6_,_._.Distance to nearest lot line,---17-;� ---------- .3 ---------Depth----;?��---- ----------- - Number of pits-------7-----------Lining materiaLO-1 __.------I----Size: Diameter.... Cesspool: Distance from nearest well-----------------Distance from foundation_--.-.-.-.-.-_----- Lining material--_---._.-._-.___._-----.--_--._Size: Diameter-------------- ----------------------Depth--------------------------- ----------------------------gals, • ------------------------Liquid Capacity Privy: Distance from nearest well--'-------------- --------r----------------------Distance from nearest building--_.-_-_-__--.------_--__-_ ------ ED Distance to nearest lot line Remodeling and/or repairing (describe)------------------------- -------------- --------- - ---------------•-------•---------•-----------------•---------•------------------------•--- describe):--------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------n------------------------------------------------------------------------------ --------------_--------------------------------------- ----------------------------------------------------------------------------I----------------------------------------------I---------------------------------------- ------------------------- ---------------------------------------------------------------------------:-------------------11--------- -------1-1------------------------------------------------------------ ---------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Coun ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)---------- ------------------ --------------------------- ------- --------------------I-----------------------------------------------------------------P.Wnw and/or Contractor) By:....---------------%-A---./- 1 -- ------------------------ -------------------------------------------------------------------------------(Title) 7 (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------------ REVIEWEDBY------------------------ ------------------- ----- ---------------------- ---- -------------------------------------------- DATE------------------- BUILDING PERMIT ISSUED--------------------- ----------------------------------------------------------------------- DATE ----------------------- Alterations and/or recommendations:-_------------------------------ - ------------------- ---------- - --------------------------------------------------------------------------------------------------------------- ..- -------------------I---------...I------------------------------------------------------------------------------------------------ ------------------------------------------------- ---------------- ------------------------------------------------------ --------------------- -------------- ----------------------------------- -------------------- ------------------------ -------------------------------------------------------------------- ------------- ----------------------------------------- ------------------------_--- - ------ -------------------- ------------------------------------------------------------------------------ ---------------------------------- A FINAL INSPECTION BY------ ------- -- -------------------- Date-------------4 ------------ ------------------ SAN JOAQUIN LOCAL HEALTH,DISTRICT J! 130 South Amer'ican Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 10-52 Revised W-2100