21487 - Laserfiche WebLink

Home Browse Search

FOR O'FFICE'USE: APPLICATION FOR SANITATION PERMIT Perm1+ No. -1 Fz __ (Complete in Duplicated Date Issued ----1----- = = 1 - ------ This Permit Expires 1 Year From Date Issued Application is her made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is ma a in compliance wit County Ordinance No. 549- . JOB ADDRESS LOCATIO � --- - --•--- ----- -� . Phone------------- ---- - Owner s ame- AAress ------ -•--- Phone-- Contractor's Name------ ------------ Installafiofi - -•- - Installatian will serve: Residence partment House Commercial ❑ Trailer Court. Mo Or 0 Number of living units: _��t of bedrooms -------- Number of baths _-__..-. Lot size ----- -- f . Wate��Supply: Public system ity system ❑ Private"'® Depth to Water Table . �ft. ! Character of soil to.a depth of 3 feet: ,Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Cla Adobe ardpan ❑ --------------- No New Construction: Yes o ❑ FHA/VA: Yes ❑ No ❑ ) Previous Application Made. (If yes,date-_.. 1 � ❑ TYPE OF INST ALLATlO N AND SPECIFICATIONS: ;'I �. (No septic tank or cesspool permitted ifhblic a er is available within 200 feet.) S. -(/-...._.Material Septic Ta Distance from nearest well..... ...........Distance frodfoundation_.__ - �''} Sizic�ui� depth?...-- Capacity/_ ip- No. of compartments._ �rom �orl;lc j � ( ! stanation...._.L...----Distance to nearest lot lin Disposal Fi d: Distance from nearest well. .{ f' �,. - -�---_------Width of trench a.__<---- �-- Number of lines_- ----.--- -- Length of each line �. Total length-------------�-�•�----- --��' Type of filter materiaL� Depth of filter mater.ial---1_-f------ Di tante to nearest lot I Seepage Pit Distance to nearest we110 1 -----Distance from;foundat ion.._./ - ��° �� { ----.-Size: Diameter...."T Deptn_ v1 Number of pits. .:.............Lining material__.. ------ Cesspool: Distance from nearest well............. Distance from oundation----.____--.-----..Lining material-- ___------.-- ----------- als. -- _-.----Li uid Ca acit 9 Size: Diameter---------- -------- ---- -- ----Depth---- -----=----- ,--- -----t--------- --- - , El r� Privy: Distance from nearest well.--- --- -------- , --'--Distance from nearest building Privy-. ❑ --- x Distance to nearest of line--------------------------------------------- ---------------------------------------------------------------------------------------- t ----------------------------------------------------------------------------------------------------------- t Remodeling, and/or repairing (descr.ibe]:._.__-- __...___-.. - t ! hereby certify that I have prepared this application and that the work will a done in a cordance with San Joaquin County ordinances, a and ruI and re ulatio ofthe Sian Joaqu'n Local He District. R:„ - -- --------------------- LO {� Contractor) (Signe -- --------- - - ------ Title By:.-•---------------------_---- ---- -- ----- ---------------------------- { )---------- ;- . ........ (Plo plan, showing sixe of lot, location of system in rel n to wells, building a c., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- --_-- --- -------------------- DATE----- 6 ___ A _ ---------- ---- DATE----------------------------- - .��. i --- ----- --------- DATE---------------- -- ------ ---------- ------- ------------- RE LDI NG PERMIT ISSUED ED -- �� `A -----------------------•- ------------------------------------- i Alterations and/or recommendations:..._.. a ----------------------------------- ------------------- --------- ----- --------------------------------------------------------------------------•----------- / . . ------- -- - - --- ---------------------- ------- --------------_------ ------------------------------------ ----- ------ - -------- - FINAL INSPECTION BY:------ ------ Date ------------- :. SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CC- ,