3754 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. . . ------------- (Complete in Duplicate) �3 3 Date Issued -____- •-• -_--- N~ I cation is Hereby made to the SanlJoaquin Local Health District for a permit to construct and install +he work herein described. gThs application is made in compliance wi+h County OrdinancE No. 549. ------------------------ ---- - - -- ^-- ^ '- ^'/ / JOB ADDRE53� Q LOCAT N.... - F --- -------------- ---------------------------------------- _� _.. i �7 Owner's Name . - --- -- - ----- ---------- -- -- - ---- -- "'-------------t-------- --._. Ph ne � �'✓ - ! ' Address-----J.T .11�--1---'-------------- ii ------------------ Phone----------------------------------- - Contractor's Name ------i Ft Installation will serve: Residence Apajunt House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other of living units: _ __ —Number bedrooms ___ __-_ Number of baths _ _ __ Lot size __ _ ------ Number x . Water Supply: Public system [vCommu iy�sy`sternw❑ Pr.iCa '[' " o Water Table _______ ft. I Character of soil to a depth of 3 feet:; San'c ❑ Gravel ❑ Sandy Lo; No lay Loam ❑ Clay ❑ Adobe�ardpan ❑ i s Application Made: Yes No New Construction: Yes ❑Prev ou pp � ❑� � . TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r Septic Tank: Distance from nearest well-----------------Distance from foundation___________________Material____:__4_____.__.-__.-----________._._________- W No. of compartments------ -------------------Size--------------------------------Liquid depth--_-�----------------- Capacity �------ it Dispos Fie Distance from nearest w`IL_�. ._Q____Distance from foundation__ istance to nearest lot-line line __ f � Number of lines------------ _J_____.___-__. Length of each line__ _Q.-'`�f ��-WVidth of trench ______.__. Type of filter matef is. - - p ------ well +A of filter material___-_._1_$_____._Total length ___1__ __Q _________________._ � f Seepa Pit: Distance to nearest well__ _________________Distance from foundation------------------- Distance to nearest lot line----_...______..- F Number of pits.-----I-------=1 t Lining material-----------------------Size: Diameter----------------------- Depth--, ___.------------------------- i Cesspool: Distance from nearest well____________.___Distance from foundation_______.______.___.Lining material-------------------------------_____El . ----Depth--------------------- ------------------ ----------Liquid Capacity----------------------------ga Privy: Distance from nearest wll-------------------------------------------------Distance from nearest building---------------.----------------------- ❑ Distance to nearest,lot lime-------------------------------------------------------------------------------------------------------------------------------------------- Remodeling and/or repairing {descrlbej:---- ------{ _v.-----------:------•---------------------------------------------- ---------------`---------------------------------------- --------------- I --------------•--•------------•------------.-- { ---- -----•r----------------------------------------------------------------------- 1------------------------ ---------------------------------------- -------------------- ` I ---------•---------------------- -•-------------------------------------------------------------------------------- --------- ---------•-------------------------------------------- - ------------•------------------------- ----------------------=---------------------------------------------- I hereby certify that I have prepared a plica ion and thatthe work will be done in accordance with San Joaquin County ordinances, State laws, and.rules and ie ul .io � g �lof the, Joaquin Local-Hea[tlr'District� --, ------ = _ ' 1 �------------------------------- * ---- Owner and/or Contractor {Signed]------� -= - - - - --- -----c; - , Bf ----------- ----- --- I - -- ---- - --------------------- ---------------- Y•--------- --- - - --(Tit - - �.--- (Plot plan, showing size of lot, location of s rp in relation to wells, buildings, etc., c n. e placed o reverse side). . }FOR DEPARTMENT USE ONLY a n 1 APPLICATION ACCEPTED BY- ' f .,...� �----------- DAT ------------------------ NAT ---------- N REVIEWEDBY--------------------------- �/ `------------ ------------------------------------------------------------------- DATE-- -1------------------------------------------------ BUILDING PERMIT ISSUED -------- ---------- DATE - Alterations and/or recommendations:__.s___._ �•�--- :- - --= -�------------ ------------------------- r . I ------------- ----------------------------------------------------------------------------------------- ---------- E -----`- ------------- ---------------------------------- j • . t --------------------------------------------------- ---I-------------------------------------------------------------------------------------------------------------------------------------------------------- -------- -----•-------------------------------------------------------------- --- --------------------------------------------------------- ---------------------------------------------------------- ------------------------------ --------------------I------------------------------------------------- --------------------------------------------------------------------------------------------------- ------------------ ----------------------------- --------------------------------------------------------------------I--------------------------------- - ---------------- ------------- FINAL INSPECTION BY:..- --' l�_� / ------------------ Date 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