3541 - Laserfiche WebLink

Home Browse Search

�J 3 APPLICATION FOR SANITATION PERMIT Permit No.-� . __. I in Duplicate) (Complete P Date Issued is hereb made to the San Joa uin Local Health District for a ermit to c nstruct and install the work herein described. �pplicationY q P This application is made in compliance with County Ordinance No. 549 JOB ADDRESS AND LOCATI N______�______�_ -rCJ_e____ _. - ----------- ------------------------------------------------------------------------------------- Owner's Name-------------------_----- ••. -------- - --------- -------------------------------------------- Phone------------------------------------ Address•--•••-••--•--••--••--•••. •--•-- ••--•• ----�� - ---- - ----- .................................................. �� / Contractor's Name------ a � ------.4 ---- - -• -------•--- Phone----7- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _/___ ber of bedrooms _4__ Number of baths _/-___ Lot size --_-------------------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Tablery ft. Character of soil to a depth of 3 feet: ,Sand ❑ ravel ❑ Sandy Loam ❑ ay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public seyjW is available within 200 feet.) Septic Tan Distance from nearest welwWl(r'_ __Distance from foundation_�_G4_________.Material _ __ __ _ _ _ ❑(� No. of compartments___ ________________ ize__,;, _ / ,5__:___i_iquid.dap .__ _, ____ Capacity___. Disposal Fi Distance from nearest wel�: istance from foundation V ----- .Distance to nearest lot line_/0-_ r`` ❑� Number of lines--..—,-?-------- __ ____ __Length of each line__�d _�!�_._____.Width of trench___ _ W T e of filter material _. _!�� De th of filter material__,l ______. Total length__'________ _- ____.___._..______ Yp �--�--------- p -- Seepage Pit: Distance to nearest well----------------------Distance from foundation_...................Distance to nearest lot line---------_------ V ❑ Number of pits----------------------Lining material---------------- -----Size: Diameter-----------------------Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from-foundation Liming material------------------------------I------ ❑ Size: Diameter--------•--- -•-------------- -,.,Depth................................. -----------Liquid. Capacity-- -----------------gals. "J Privy: Distance from nearest well-------------------------------------------------Distance from nearest building_____-_______________________-_-____-_. ❑ Distance to nearest lot line--------------------------------- •------------------------- ------------------ ---------- --•--- ---------------------- ) - � Remodeling and/or repairing (describe ------- ------ ---- ---------- --• - - •---- ' � --------------------------------------------------------------------------------------------------------------•----------------------------••--------------------------•---------------------•-•----------r---------------- ------------------------------------ ------ --------------- -- -- ----------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in acoordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)........ 1 , � �( �, � - (Ow and/ Contractor) By:......... ✓ !/L/ ---------------------------------------------------------------------------(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------------------------------- T-c" ---------------------------------- DATE...------•o;, 1.34-Z-3---------------------- REVIEWEDBY----------------------_----------------------------------------------------------- --------------------------------- DATE------------ BUILDINGPERMIT ISSUED---------------------------------------------------------............................................. DATE----_----------------------------------------------------- Alterationsand/or recommendations----------------------------------- --------------•--------•------------------------•--------------------..---------------------------------------------------- -------------------------------•-------------------•------•---__------------------------ ---------------------------------------------------•-----------------------------------------------------------------------------•-- ----------------------------------------------------------------------------------------------------------------•-------------------------------------------------•-----------------------------------------------•_--------- ----------------------------------------------•-------------------------------------------•--------------------------------------•--------------------- __......- ----------------- - ------------------ -----------------------------------------------------------------------------------------------------------------------------------------------------------------------------•----------------------------•------------------ FINAL INSPECTION BY:------- ' ._/tel, -� Date_-------------� r`�-------- -------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American 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