2194 - Laserfiche WebLink

Home Browse Search

Permit No. APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Date 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. 4 �. LOCAT-I-O JOB ADDRESS "Owner's Name----- -=------- -- -------.-- -_-_ ---------------- ----------- -------------- -------------------------------- Phone 5 .. Address-- _r �' ----------------------------- -------------------------------------- Contractor's Name-- ------------------------- -- - ---•-----=------------ -- ------------------------------------------------------------------- Phone Installation will serve: ResidenceApartment House ❑ Commercial ❑ Trailer Court 11Motel ❑ Other [] Number of living units: ___�___ umber of bedrooms _Z._,NUmber of baths ---1--_ Lot size _!_-Q-_ ---------- Water Supply: Public system Community system '❑ Private ❑ Depth to Water Table--------- ft. Character of soil to a depfh'of 3 feet: S;�PN'ew Gravel E] Sandy Loam Clay Loam E] Clay E] Adobe [Hardpan [❑ Previous Application Made: Yes ❑ No Construction: Yes o ❑ ' 4 TYPE OF INSTALLATION AND SPECIFICATIONS: IG w,a (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 6r Septic ank: Distance from nearest well---_____-_ ------Distan_ afro f,,oundation___ _-- MaVer )-- ___ _______ ----- ---- --------------- No. of compartments----------�� ---------Size--- ( `� X Liquid deth-------- ----------Ca Capacity SQ-Q� - +� f p tY--- Dispos Field: Distance from nearest well--_`-_ '---_Distance from foundat'on_r__t`a�-i_---____.Distance to nearest lot lin Number of lines------ --Length of each line___ -c _Q_'-�QWidth of trench----------- Type o f filter mater; epth of filter material �_!5I_ ___: Total length______------- V-0---------------------- Seepage ---------- Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------------.Distance to nearest lot line--------._______- ❑ Number of pits------=---------------Lining material-----------------------Size: Diameter------------------------Depth---•------------------- _------ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-----------------------.__ ❑ Size: Diameter------------------------------- Depth Liquid Capacity ---gals. Privy: Distance from nearest well __ ___________ " Dis#ante from nearest building_________________________ ❑ Distance to nearest lot line .--------------- Remodeling and/or repairing (describe)______________________________ --------------------------------------------------------------------------------------------------- -------------------------------------------- -------------------------•--------•----=---------------------------•---------------------------•-- 4 ., ---------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations-of the San Joaquin Local Health District. Q4;5) - (Signed)_- --- --- -----------(Owner and/or Contractor) By:---------------------------------------------------- - Title ----- ----- ------------- ---- ------------------- ------------------------------------------------- (Plot plan, showing size of lot, Iota+ion of system in re ation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY .APPLICATION ACCEPTED BY --------- --------------------------- -------------------------------------- DATE_ REVIEWED BY------------- - , --- ---------I---------------------------------------------------------------------- DATE -------------------------------------------- BUILDING PERMIT ISSUED--------------------------------------------------- ------------------------------------.-- DATE------------ Alterations and/or ret mendafions:--- __._-_---------------------- ---------_--_ - -- ----- -- - --K----, f-- - -------------- 14 - = __ _ ._------------------------------ ---- _------•-------------- - x :}::::::: :: :::::: :--:::::_:1: .:::_::::-:-::::_:::: 4,4-KA.&j),A -_ ------ ------ - - - - -- -- - ::: FINAL INSPECTION BY: ------------ ='` �• Date = f � !47 �' SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Sfreo+ 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockfon, California Lodi, California Manteca. California Tracy, California ES-9-2M 9-51 Revised W-2100 _. r