3346 - Laserfiche WebLink

Home Browse Search

�\ APPLICATION FOR SANITATION PERMIT Permit No, .... .. ,-_._____-- (Compm t Duplicate) lete in Du p ] Date Issued 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. 549. JOB ADDRESS AND LOCATION_____1_2,41---- ....... .. � -- � rr � •t .................. ------------- Owner's Name--------------------------------- Jn.. .7Td-l�t� �r�"^ - Phone--------------------- - --- `-------�----,-- --A---------------------------------------- Address------------------------------------------------ Sfarf •_ ----------------�'- Contractor's Name-------------------------------Pc a= _.._- -- ------------------ -------------------------------------------- Phone------ ._4 Installation will serve: Residence K, Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -j----- Number of bedrooms _Number of baths ---/-. Lot size ________ --___.-._._ Water Supply: Public system ❑ Community system ❑ Private ,-Depth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Aclgbe�,Hardpan ❑ Previous Application Made: Yes ❑ No Hew Construction: Yes ❑ No ❑ ,f�=. y TYPE OF INSTALLATION AND SPECIFICATIONS: r (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tan _ Distance from nearest well------------------Distance from foundation-------------------.Material---------------.__--____________________________ �- No. of compartments-------------- __Size________________________________Liquid de th___..-__------ ----Capacity _____ Disposal Field: Distance from nearest well__ ------Distance from foundation____�_ --_Distance to nearest lot line---/_a__-- Number o.1 � iines___._______ _i--------------__Length of each line____ ___�S____-__-____Width of trencj�___ _.4�_=__________.____ Type of filter material___�.,y.• -0t,-_.Dep+h of filter material----IS"------Total length---6-_S-_`_________________________ Seepage Pit: Distance to nearest well____------------------Distance from foundation------------------- Distance to nearest lot line_.--___._________ ❑ Number of pits---------------------Lining material-----------------------Size: Diameter-----------------------Dept h-----------------------_--------- Cesspool: Distance from nearest well________________Distance from foundation--------------------Lining material-_________-___._____.______.________ [] Size: Diameter-------------------------------------Depth----------------------- ------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-----------------------------------------___.._Distance from nearest building-------------.________________--__-__---- ❑ Distance to nearest lot line------------------- ----------------------------------------------------------------------------------------------------- ------ Remodeling and/or repairing (describe)----------------------------------------------------------------------------- ------------------•-------------------------------------------------------- ------------•------•------•--•------------•------------------------------------------•--------------------•-- -------- -•---------------------------------------------------------------------------- - ----------------------------------- --•-----------•------------•-------------------------••-------------------------------••-------------•---------------------------------------------------------------------------- 1 hereby certiY4�� an have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State Irules and regulations of the San Joaquin Local Health District. tl�scr-- g i ------ (Signed) ft' ---------------- Owner a d of Contractor ------------------- T ------------------------------------- By: / . ] By:........................................................................----- ----------(Title] �? =1�rr: 1!Q..�!..........--••-•--•---. (Plot plan, showing size of lot, location of system in relato wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------------------- -------- ------ ---------------------------------------- DATE--------------- ------------ REVIEWEDBY----------------------------------------------------- - --------------------- ------------------------------------------ DATE.------- --------------------------------------------- ---- � BUILDING PERMIT ISSUED --------------------------------------------- ------ DATE------------------------------------------------- Alterationsand/or recommendations--------------------------------------------------•-------•---------------------------------------------------------------------------------------•------------ --------------•------- -------------------------------------------------------------------------------------------------------------------------------------------.---•---------------•-------------•-----•------------------- -------------------------------------------------------------•------------------------------------•------------------------------------------------------------------------------------------------------------------- •--- --------------------------------------------------------------------------------------------------------------------------------------•-•------------------------------------------------------------------------- FINAL INSPECTION BY:------ �-�" Date - -?t—> -1' 4 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 `.