4647 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. .. -• • (Complete in Duplicate) Date Issued -a---r• -`-r-3 Joaquin Local Health District for a permit to construct and install the work herein described. Application is hereby made to the San This application is made in compliance with County Ordinance N 549. JOB ADDRESS AND LO A N--------- ------ -- ----- ----- '---------_------------------------ -------- --------------------- Phone---------------------------------- Address------------ -------•-------- -------------- Address.---•------- --------------------•--------•--------•------------------•-----------------..------•--------------------------•-------------------------------------------------------------------------- Phone------------- ----------- ------------•----------------------••------ Pone,---•-------- ----------••-------- Contractor's Name------------------------ 1 = Installation will serve: Residence partment House ❑ Commercial ❑ Trailer Court [3 Motel ��❑ Oiither /I _ Lot size -------� ------------------ ----- --------�---------- Number of living units Number Number of bedrooms ---J--. Number of baths -_.I-__ Water Supply: Public system mmunity system ❑ Private ❑ Depth to Water Ta� _---lay 0 El � Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay Adobe ar an Previous Application Made: Yes'[] No X_ New Construction: Yes"K No ❑ a TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet" f ,,, ) Material. - Se tic Tank: Distance from nearest well-r�LDistanc #r foundation.- -, -- - _. Liquid d th- -Capacity_ 6� No. of compartments _-- -- ---Size._ ---_ � f� ! d tante from foundation-I_Y_- Dis ante to nearest�lo�tlli.e_-- Disposal Field: Distance from nearest weal_ ' �O Wid}h of trench..- .,..�°I`j --- - -----• Number of lines___........-l..._ Length f each line---- ---- Total len the._. _-- 4' - ------•---- - Type of filter material... .T--------------Depth of filter material- .i- --=-.-.-- 9 45 + _._.Distance to nearest lot line................. � I Seepage Pit: Distance to nearest well----------------------- from foundation................ Depth-.-..._-..line- ....-.--__....I ❑ ------Lining material-----------------------Size: Diameter--------------- Number of pits---------------- Cesspool: Distance from nearest we}{-----------------Distance from foundation_..._..------_-----.Lining material.------._.---..___.._-----__._ Depth ---------Liquid Capacity----------------------------9815. ' ❑ Size: Diameter------------------------- p 11-1101..a..nearest building.-__------------ ---------- Privy: Distance from nearest well------------- -------------------- Distance from - ❑ .... -_-. ------.- Distance to nearest lot line----------------------------------- -------- ------ - ............ Remodeling and/or repairing (describe :--------------------------------------------------------------------------------- ------------------------ -------•--- ---•---------------------- , -------------------------- certify t at I have esprepared regulations application the San Johat th wo HealthleDistr'Ic#n accordance with San Joaquin County I hereby ceraquin ordinances, S � - -----------------------(Owner and/or Contractor) (Signr ------------------- IX --------------------------------- - ---- -------------------------- (Plot plan, showing size of lot, location of system in relation to wells' buildings, etc., can be pl ted on reverse si e . FOR DEPARTMENT USE ONLY i ------- DATE- / v --- -------------------------------------- APPLICATION ACCEPTED -- ------- DATE---- ------- -•---------------------•--------------------- f REVIEWED BY--------------------------------------------- --------------------------------------------------------------------- ----------- ---------- DATE------------------------------------------------------------- BUILDING PERMIT ISSUED --------- --=----------------------------s---------------------••------------- Alterations and/or recommendations:._----------- ----------- ----------- ----------- .. ----- - '15 -------- ---------------- ------------------------------------------------ - - ---- ------------------- .. Date----- FINAL INSPECTION BY:-----------;ies l-""�------------------- ------- .� ...----� -------- --- -_-- SAN JOAQUIN LOCAL HEALTH DISTRICT 132 Sycamore Street 814 North "C" Street I 13o South American Street 300 West Oak Street Trac California Stockton, California Lodi, California Manteca, California Y� CC—R_7M 1052 Revised W-2100