9417 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. _._�.. .......... (Complete in Duplicate) o ,�, 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 LOCAT ON-._---- ____.____ / C � ----------------------------------------------------------------- . ---------------------- --------------- Phone-------------------- Owner's Name------- ------ ,,,,�`----�f-�--�L�--------��-��J--------- ----------`�- --------•--•--- Address-------------ll- -�f !Y__ �/f✓/.�SQ_n _.. - ' Contractor's Name. s___/�� Phone__ 4' ly Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---f__ Number of bedrooms ---/--- Number of baths Lot size ________-_-9- Wafer 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 ❑ Adobe A Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ 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----/Y-Q_`*E Distance from foundation__/0 __.___.Mates iaf__. /2lG` ___________________ p Size---.�_ _!�4`_ -----Liquid depth---------i - -�P-----Capacity----- No. of compartments-- ____ __ _ os I11F�q6f• Distance from nearest well-----------------Distance from foundation-__________________Distance to nearest lot line----------------- 7 Number of lines-----------------------------------Length of each line-------------------------------Width of trench----------------------------------- Type of filter material-------------------------Depth of filter material----------------------- length------------------------------------------ �ge� '� i . Distance to nearest well----------------------Distance from foundation_______..__..-..___.Distance to nearest lot line----------------- C`K Number of pits----------------------Lining material----------.------------Size: Diameter----------.------------.Depth------ _-----.------------. Cesspool: Distance'from nearest well----------------- from foundation--------------------Lining well material______________________________________ ❑ Diameter Depth ----- __ - --- --------Liquid Capacity---------------- gals. Privy: Distance nearest ------------- -- --------. fDistance from ` nearest building------------------------------------------ d ❑ Distance to nearest lot line----------------------------------------------------------------------- -------------------------------------•-------------------------------- Remodeling dad/or repai6 scribe):-------------------------------------- _ - -------------. --- •-•------------ ---- - - ------- � rr„� �- --------------------------------------------------------------------------------------•----------------------------------------------------------------------- ----------------------------------------- ------- -- --------- 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 les and regulations San Joaquin Local Health District. �_-_`` �-rt'-- ----Ow er and/or Contractor (Signed)--------------------- - L ----- ) �Y= ----------- -*------------------------------- (Title) (Piot plan, showing size o `fot, location of system in etion to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -- rr � -------------------------------------------- ---------- DATE--- J"Q d''� 1 -------------------- REVIEWEDBY---------------------------------------- -- ---- ----------------------------------- . DATE-------------------------- BUILDINGPERMIT ISSUED----------------------------------------------- ----------------------------------------------------- DATE-------------------------------•------------- Alterationsand/or recommendations:--------------------------------------------------------------------------------------------------------------.---___------------------------------------- --------------------------------------------- ----------------------- ----------------------------- -----------------------------------------------------•-----------------••---------------------•-------------------------- FINAL INSPECTION BY: ��- `_ c -- ------------ 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 ES-4---2M Revised 1.57 F-P.CO. _S