4389 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. - (Complete in Duplicate) Yvlp/�73Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein escribed. This application is made in compliance with County Ordinance No. 549- JOB ADDRESS AND LOCATION_ - a ---------/04.V - - Owner's Name------------•--�,� _. _-�, Address-------- ---- Phone JJ -----•---------- ------- ------- ------- s Name-------- -.l1...... _ -_ l -p- ------ _'- " - -phone-- Installation will serve: Residence El Apartment House E3 Commercial ' ❑ Trailer Court ❑ M Number of living units: __ otel ❑ Other Wafer -------- Number of bedrooms -------- Number of baths -------- Lot size -------- Publics stem Supply: Y E3Community system ❑ Private [I Depth to Water Table -------- ft. Character of soil to a depth of 3 feet:' Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam E] Clay ElAdobe Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: 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-----------------Distance from foundation--------------------Material ❑ No. of compartments------------ -------------Size_----_----- - ----- -------- -Liquid depth-------------- ------ _ ----C___a__pa__ _d_ _tY__ •---- ------ ---- ---- isposal Field: Distance from nearest well-------- ------ -Distance from foundation _-Distance to nearest lot line______--________- ❑ Number of lines-----------------------------------Length of each line----------------- ---- of- Type or' filter materiall----------------------Depth of filter material-----------------___-=otalthlength nc--____-___--______--_______-___--_-..N Seepage Pit: Distance f nearest well______________-___---Distance from foundation--------------------Distance to nearest lot line-_---_---------- ----------------------- ❑ Number of pits___ _________________Lining material Size: Diameter Depth Cesspool: Distance from nearest we -------------_-- "-- 1 _-Distance from foundation-------------------- material__-_______-_-__- ❑ Size: Diameter----- -------------------------------Depth------------- ----------------- I Liquid Capacity---- ------------- -----gals. Privy: Distance from nearest well ``"`�-_ B.�---------------Distance from nearest building----5-0-- --�-------------__- /�--------------------------------------------- Remodel' and/or repai ing (describe): / _ �_�_.r� v►�-_.------- e4 -,_--- �__:____._: _�_�- -------- ------------ �! --- ------ - ____________---------------------------------------------------------------- -----------------------------------------______________________________________________________________________________________________________________________________________________"_____--_-___-_-____-___--__-____--_-- e 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 rules and regulations of the San Joaquin Local Health District. Y (Signed)---- 3--'---------�:-----:."� '��?,��'_---i-- - ----------------------- ----- -----(Owner and/or Contractor) ---------------------------- BY:-------- Tetle ------� --------- --- -------- _ (Piot plan, showing size of lot, location�of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEP MENT USE ONLY APPLICATION ACCEPTED BY----- REVIEWED BY S--- -------------------------------- -------- DATE------ --- .! � - -----. DATE-------------------- - -----------------•------- BUILDING PERMIT ISSUED-------------- i ---'----- "-------- '------ -------------• --------- DATE-------- Alterations and/or recommendafions---- ---------------" --------------------------------------------------------------*----------*-------------------------------------------------------------------------------- -------------- ------------------------------------------ - •- ----------------------- i ----------------------- -----------------------•-------- FINAL INSPECTION BY:--------�! ------ � _ i I ----- ate----- ---- -- - 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