2866 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued -glFl...... 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 Count din e No. 549. Z/ JOBADDRESS LOCA ,ON -- ---- -----I--------- -------------------- -- --------------------------------------------------------------------------------------- ---- --------------------------- Owner's Name---- ----- --- ------------------------------------------ --------------------------------------------- Phone------------------------------------ Address---------- --------------------------------------------------------------------------------------------------------- ----------------------- -i Contractors -------------------- Contractor's Name--- ---- - ----- - ------------------ ----------------------------------------------------------------- Phone.--------------------------------- Installation will serve. Residence Apartment House Commercial E] Trailer Court E] Pote), E] Other 171 Number of living units:3--- Number of bedrooms A3- Number of baths Lot size ----- ------- -x ------------------- Water Supply: Public system � Community system C] Private E-] Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand E] Gravel El Sandy Loam E2r Clay Loam E] Clay E] Adobe 2(/Hardpan E] Previous Application Made: Yes E] N o E] New Construction: Yes No El TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tarjk: Distance from nearest well-----------------Distance from foundation-------------------Material------------------------------------------------- No. of compartments- $jze-------------------------------Liquid dept -------------------------Capacity-----------* 01 I Fie Distance from nearest--------- -----------_Distance from found i ----- ----4Dksfance to nearest lot line Diswell_!*4 Number of lines___------- Length of each -- -------- id+h of trench-_-_--._ - ---------------- Depth of filter material__:________ _ -Total length_____________ Type of filter material% ---------- le Distance to nearest 11----------------------Distan ion- istano to nearest I f ---- ---- v�6p& & �61, 1 e.- Diameter-__-_.53 IT Number of pits___________________Lining materia ----------- Depth-- ------------------- Cesspool, Distance from nearest well-----------------Distance from foundation -------------------Lining material____________________________________ ❑ aterial------------------------------------- F1 Size: Diameter--------------------------- ----------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building_--_---_----.--_--___-_-____________-_-__. ❑ Distance to nearest lotp'ne------------------------------------------------------------------------------------------------ ----------------------------------------------------- ---------------- --------- Remodelin and/or repairing (describe)___ -..Jp------------ - ----------- -�G ..... ....... ... .. .............. --------------- ..... ------------------------------- ...... ............. ------------ ------------------------------------- --- ------7-ep------ ------------------------------------------------------------ L---------------------------------------I-------------------------------------------I ------------ -------------------------------------------------------------—,--------------------- ------------------- - I ere6y certify that I have prepared this app +ion and that the work will be done in accordance with San Joaquin County ordinances, State laws, an rules and regulations of the San Joaquin I Local Health District. (Signed)-------- ------------------------------------------------------------------(Owner and/or Contractor) By:-------------------------------------------------------------------------------------------------------------------------------------(Title)---------------------------------------------------- ------ (Plot plan, showing size of ]of, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- ---------------------------------------------------------------------------------------- DATE -W-7 ---------------------- REVIEWED BY------------------------------ ------------------------------------------------------------ ------ DATE - - - BUILDING PERMIT ISSUED---------- - ------ DATE-___ Alterations and/or recommendations:----------------------------------------- ----------------------------------------------------------------------------------------------------------- -------- -----------------------------------------------------------------------------------------------------------------------------------------------------------------------I----------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------- ------ -- ---- �)-------------------------------------------- ---------------------------------------------------------------------------------------------7--------- A%� % 0 FINAL INSPECTION ----------- ----------- ----- Date------�-1 k-- ------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wes+ Oak Street 132 Sycamore Street 814, North "C" Sfrev+ Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 8-51 Revised W-2100