7182 - Laserfiche WebLink

Home Browse Search

141/ APPLICATION FOR SANITATION PERMIT Permit No. ."1.-t._ ._ .._._... • (Complete in Duplicate) • � Date Issued Applica4-ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. r This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATIO ....... ...._ _l --_..�--- ----��.�--------;�-------------------- -- ---- ------------------------------------------------------ Owner's Name---- - -----•----•------------------------------------------------------ --------------------------------------------- Phone------------------------------------ Address----45--�.O---- ------- -------------------- -•----------------------•------------------------ Contractor's Name---- - ---------------------•-------•----------•---------------------------------------.--------- Phone_A-__ - Installation will serve: Residence artment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other, ❑ Number of living units: _/--- Number of bedrooms I___ Number of baths 15&__ Lot size ___ Water Supply: Public system ❑ Community system ❑ Private [4=Bepth to Water Table do ft. Character of soil to a depth of 3 feet Sand 0 Gravel ❑ Sandy Loam ❑ Clay Loam [❑ Clay ❑ Adobe ardpan ❑ � Previous Application Made: Yes ❑ No New Construction: Yes A " TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) , Septic Tank: Distance from nearest well--- Distance from foundation.___� ___.____Ma+erial____ _ _______ No. of compartments._-_j' ___._____...__Size-_��f' ._.�C- �----Liquid depth_y„+'f+`" ---------------.Capacity..?_.AqP-------- Disposal Field: Distance from nearest�w.}ell_.�i. &_l_-._.Distance from foundation.__1P---------Distance to nearest lot line------------- Number of lines--------— 4-------------Length of each line j�_Q'_!�!',�_��Z�/idth of trench--- -___________________ s Type of filter material___._1. - of filter material-----A�------__-.Total length---- _oQ_______________. 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__: ------------------De th------------------------------ ---------- - ----Liquid Capacity all. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----------------------.---.--------------. \ ❑ Distance to nearest lot line--------------------------------------------- ----•-•-------------------------------------------•------------•------------------------------- Remodeling and/or repairing (describe):-- ------ -----------------------------------------------------------------------------------------_------------------------•------- ------ -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------- ---------------------------------------------------------------------------------------------=---- _--------------------------_------------_1------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State aws, and rules egulations of the San Joaquin Local Health District. �O ner (Signed). Contracfior� `----- ----- ----------- By: 's^-'-'-y-`------v------------------------------------------------------- ----(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---------------------------- -------------------------- REVIEWED BY-------------------------------- - DATE_-a PERMIT ISSUED------------- -- DATE------ -Y_;----------------------------------------------- Alterati;ns •;:-----------•-------------------------•-------- Alterations and/or recommendations:-`----- --------------------------------------- -----------------------------------•---------•-•-----------�•-----•--------•--------•--------------------- I ------------••-------------------------------------------------------------------------------- --------------------------------------------------•--------------•-•-------------•------------•---•----------------.. -----•----•----------------------------- -----•------------------------------------------- -------------- --------------------------------------------- -------------------------------------------------------------------- ---------- ----------------------------------------------- ----------------•---------- -----------------------------•------- ---------------------------------- -•---------------------------------- ---------------------•----------------------------------------------- FINALINSPECTION BY:- ------- - ----•--•�(--------------•--•---------------- Date------------------.------------------------ ---------------------------------- 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 E5-4-•-2M 145446 nTw000 12-54