5082 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No.C`________ .____ (Complete in Duplicate) Date issued --- 1-131 Applica;-ion 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 AND LOCATION----�-3--------5th-'....... N-O-------------------------------------- --- Owner's Name----------- l�C/_ ��---------------- -- -- Phone------------------- -- ---------------------- --- -- ------ - ---•---- ------._ . ....-•-•---•---- Address-------'J�---3-/ d a^ --- I ` Contractor's Name-------------------- ------------------------------------------------------------------------------------ Phone------�-'„- -•------- Installation will serve: Residence E4 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---1---- Number of bedrooms _2%_ Number of baths __I_---- Lot size --------- ?,_?C_-! --- ----------------------- Water Supply: Public system a Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe,R Hardpan ❑ Previous Application Made: Yes ❑ No F� New Construction: Yes, No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 1 Septic Tank: Distance from nearest welOWYLl--_Distance from foundation--1p-----___.-.Material--- --.--e----------------- ---------------- No. ---'{__.---_----_ ` No. of compartments---- _Size___x-��--3------Liquid de th-----_5f. -----------Capacity Disposal Field: Distance from near st well _Distance from foundati 4 in'_ .......Distance to nearest lot lire-------------- __J Number of lines----- -------------------------Length of each line___. l- .._. ...Width of trench.._ 4__�__-__.---_--___-_.- f Type or filter material--- � L__Depth of filter material--le- -----------Total length-------/Z-_10----.____-__ Seepage Pit: Distance to nearest well--------------------Distance from foundation-----------.--------Distance to nearest lot line----------------- 171 , Number of pits----------------------Lining material--------------------._.Size: Diameter-----------------------Depth------------------•-------- ----- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- El Size: Diameter--------------------------------------Depth----- ---------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well------------------------------------------------- from nearest building--------_-__-.__-____---_--------.-___._. ❑ Distance to nearest lot line----------------------------------------------------------------------- ----------------------------------------------•----------------------- Remodeling and/or repairing (describe):--•-------------------------------------------------------------------------------------------------------------------------------------------------- -----------------------------------------•------••----------------•---------•-----------------------------•---•----------------------------------------------------------------------------------------------------------- 0 ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------- •-------•----------------- -------------------------------------------.............------------------------------------------------------------------------------------- -------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, S to la s, and rules and regulations of the San Joaquin Local Health Disfrict. (Signed) =f��.�' --------------------------- ---- -------------------------------------------------------------------(Owner and/or Contractor) 8Y:------------------ _.< - (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------ --- - - _,-- DATE_...��_a/ -------------- REVIEWEDBY-------------------------------------------- ------------------------------- -------------------- DATE---•---------------------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE---------------------------------------- Alterations and/or recommendations---------- -------------------------------------------------------------•-•--------•-•-----------------------------------•---------------- ----------------------------------------------------------------------------------------------------- -------------------------------------------------•..........------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------•-•---------------••----------------------------------------...--------------------------------------- ----------------------------------- ------- ---------------------- ------ -----------------------------••----------------------------------------------------------••-------------------------------------• -------- FINAL INSPECTION BY:------ --- ------ --- ------��'--------•------- Date--------------- J� 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 ; Revised W-2100