7247 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No -__/•._ •-- � " (Complete in Duplicate) �/ ^ Date Issued -il Applica*ion is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein described. This application is made in compliance with County Ordinance o. 549. JOB ADDRESS AND TION-- - - - - ----- --------•-----------•------------------ Owner's Name --------------------------------------- Phan - --------------- Owner's - ------ --- - --------- Address-•- -- - � ,�"_----- ••- ------------------------ w Contractor's Name---_------------- Phone-..-,�;1-��-•--- nsta lation will serve: Residences Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ t Number of living units: f- Number of bedrooms--- Number of baths r/---- Lot size Water Supply: Public system Community system ❑ Private ❑ Depth to Wates Tablei� __ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel [] Sandy Loam ❑ ClayLoam Clay❑ y ❑ Adobe 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.) 4eptic T k: Distance from nearest well ..--.-_--Distance from foundation-------------------,Material _---_----_-.-___..--_--- No. of compartments----- - ---- :Size----- -- ---- ----------- -------- Liquid depth ------ ---------Capacity ...... . isposaI Fi I . _ Distance from nearest well... ---.-Distance from foundation--------------F-._.Distance to nearest lot line_---__------___._ ❑ Number of lines-'--------------------------------Length of each line-----------------------:-----.Width of trench.-----------"___-- #Type or filter material-------------------------Depth of fil sial------ ------------- otal length----------------------------------------- Seepa a Pit: —`'Distance to nearest well_--�Q.-_____Dist ce f m fou a n_-.-� " �' � -�-Y.-"..Qistalce to nearest lot_ line-_-_--"----_r-_ Number of pits._/------------ Lining m eria��.r��- Si z Diameter-----"_� . _ ------- ----.Depth- `� I esspool; Distance from nearest well------------- -_Distance from found ion-------------"f..-..Lining material--.__---.-----_----- a - Size: Diameter-------------------------------- ------- ---- -------- --- Depth---- ----------- ----------- -- --------- ---Liquid Capacity-.-, gals. Privy: Distance from nearest well-- "----"___-Distance from nearest buildin ❑ Distance to nearest lot line--.---- - g ' ----- -'1 ............. --------------------------------------------- Remodeling ---•------•_-- ---_ - _-"--•_------"_•- Remodeling and/or repairing (describe): -------- fir' �Y I - i -- , -----------------•------------• ------------------------------------------------------------------------------------------------- ---------------------------•-----'--------------••----------------•-------------- -----------------------"----------------------------------------------•------------------------------------------- San Joaquin County ordinances to laws,' 90rand regulations of the San Joaquin Local Health District, (Signed)_--r---- --- �Pv t --------- ------------- Owner and/or Contractor) By----------------------------- J - - - - - -- - .(Title)- (Plo t plan, showing size of lot, location of system in relation to wells, buildings, etc., can be pl side). a. FOR DEPARTMENT USE ONLY t APPLICATION ACCEPTED BY-....... ._ --------- ------ --- DATE---- _ - REVIEWED BY_ = = ` `�� DATE -� ---r' .PERMIT.ISSUED�--------- --- y` 7- _ ----- ------- - d Alterations and/or recommendations:.-----_".-.- .- ------ DATE----- -- - -=---- -----------------•------- ------- ----------- U ------------ - ---------------------------------------•------------------- - ' ------•------"------------------- ---------- ------ �_.. /j J FINAL INSPECTION BY:------.h . .-. Date II 1j / 'T 4f ------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Y 300 West Oak Streat 132 Sycamore Street 814 North "C" Street Stockton, California ' Lodi, California Manteca, California Tracy, California ES--L'6 '2M 145996 aT wooer iz-ser