5055 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Fermi+ No ......•---••. 5 (Complete in Duplicate) Date Issued _. ---5--' ° ;' n is hereby ade to the San Joaquin Local Health District for a permit to construct and install the work herein described. Apphca io Y m This application is made in compliance with County Ordinance No. 549. r -------------- - --------- Q �4----- ------------------------------•----------------------- JOB ADDRESS AND LOCATION Phone---------------------------- -------- i C , Owners ame-------------------------------- --------•-- ---------•------•----- Address----•------•------------------- •--------- -------- --------- --- Phone---------------------------------- ----------------------- ) - Name--------------------------------------------------- ----�----------------•----- ----- --_ Motel . Other Installation will serve: Residence X Apartment House ❑ Commercial ❑ Trailer Court ❑ ❑ -----•- Lot size _.----�-�---�--- Number of living units: -- ----- Num- ber of bedrooms __�.___- Number fths r Water Table __._____ ft. Private ❑ Depth Water Supply: Publ•:c system k ComrnunitysystI ❑ Clay Loam El Clay E] Adobe. Hardpan [IEl Character of soil to a depth of 3 feet: -,Sand Gravel ❑ Sandy Loam ❑ Y Previous Application Made: Yes [DNo TYPE OF New Construct ion: Yes No [IINSTALLATION AND SPECIFI�TIONS;, �• ( No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank. Distance from nearest well4----------------Dzeance from foundati�iquid depth- Material.-____---Capacity__.__________._____"__ & ❑ No. of compartments___ _ Disposal Field: Distance from nearest well__:-------------DLenath of rom each 1 ne_ation-----••----- --.W Distance fttrenc est lot line---------------- ❑ Number of lines---•-- - --- g - Total length-------------------•---------------------- Type of filter material.=__�____z-------------Depth of filter material___--___.__---_ Seepage Pit: Distance to nearest well__-T--- i�'n mD+eral e from founds ze�Diamete`------------------------Distance to nearest lo/ ine_________________ 1 ❑ Number of pits.____ -------_ g n� from nearest well___"_(1(- -----Distance from foundation_,-_ --_._---Lining material__.______"----- ------- Cesspool: Distance ---------------------------------Liquid Capacity_-".--- ------gals. Size: Diameter----- ---�- �---`�---' -:-----Depth------------------ ------------- -- -- a Distance from nearest well--------------------------- --------- -- _--Distance from nearest building---------------------•--------------------- Privy: ----------------------------------------- Distance ------ ------- ❑ Distance to nearest, of me_____'---------------- --- ------ Remodeling and/or' repairing (describe}:-___------------------ ___. ------------------------ -------------------•------- ---------------•---------------------- ! hereby certify that ! have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, cerState laws, and rules and regulations of'the San Joaquin Local Health District. (Owner and/or Contractor) (Signed)---- (Title)- BY:----•-------------------- • ----•------------------- -- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed an reverse side). FOR DEPARTMENT USE ONLY - -------------------- DATE------- -- ------- -------- APPLICATIONACCEPTED BY------------------------------------- ------- - DATE------------ ----------------------------------------------- - ------------------------------------------------- REVIEWED BY--- ----------------------------- -------------- ------ ------ BUILDINGPERMIT ISSUED------------------------------------------------------------------ .------------ ------. -.--------------•---------••------•-------------------- Alterations and/or recommendations:---------------;- - -------- - ------------ ------------------------------------------------- ------------ -------------------------- Date------- ---------------- ------------------------ -------- FINAL INSPECTION BY ------ -------- SAN JOAQUIN LOCAL HEALTH DISTRICT 132 Sycamore Street 814 North "C" Street 130 South American Street 300 West Oak Street Tracy, California Stockton, California - Lodi, California Manteca, California