6611 - Laserfiche WebLink

Home Browse Search

%SX APPLICATION FOR SANITATION PERMIT Perm. No. ___4 ..�ll_._ (Complete in Duplicate) Date Issued Applica{ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein 's This application is made in compliance with County Ordinance No. 549. JOB, ADDRESS A LOCATION. Q ----- 'rt `-vy--- � - ----"-------------------------------------- 1 Owners Name---- ' ��--- - ------ ----- ----------------------------------------- Address.-....19 --------------------- -------------- Phone. I Address.----- .............•. ------- - -------------------- ----••------------------------------- [•-'.•__...---------------- Contractors Name---- J� • - ------•-•---••- Phone - `_ .-T Installation will serve: Reside" partment House ❑ Commercial rai er Court'❑ Motel ElOther ❑ Number of living units: Number of bedrooms -------- Number of baths -------- Lot size - �____._.x-_-_ ___ __________________ Water Supply: Public system t1cemmuni+y system ❑ Private ❑ Depth to Water Table S�pft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 61---Hardpan ❑ Previous Application Made: Yes ❑ No 6--N-ew Construction: Yes ❑ No . TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) SeptiTank: Distance from nearest well.................Distance from foundation--------------------Material__________-_..._ ..----------------- . No. of compartments---------- --- - Size__.....-------------------------Liquid depth----------- - -------- ---Capacity--------------------- isposal Field: Distance from nearest well_________________Distance from faundatian______-______.____.Distance to nearest lot line_________________ I Number of lines----------------"------------------Length of each line------------------------------Width of trench.-----------..-------.------------ [ >, Type of filter material-------------------------Depth of filter material--------.-----.------ g •- )J. Tota! length ____ __----------- ••-- Seepage Pit: Distance to nearest well_ .c__-_Distance Jrom foundation__ _ - Distance to nearest lot ....... p Number of pits.'.... ------------ -Lining material_ _._.Size: Diameter_Y3-----------Depth____ @__________________ Cesspool: Distance from nearest well-----------------Distance from foundation------------. - Lining material_____._____________._________._____- ElSize: Diameter-------------------------- - ---------Depth-------------- -------------------------------------Liquid Capacity- --------------------------gals. Privy: Distance from nearest urell-------------------------------------------------Distance from nearest building------------------------------.----------. I ❑ Distance to nearest lot line ----------------- --- ----------------------------....------------`-------------------------------------- -------------------- Remodeling and/or repairing (describe):---------------- ------------------ - ----------•-------------------- ----------------------------------------------------------------------------- ---------- ----------- --------- --•----------------- ,i_____________ ______ _ __ ____._____ __ _-._________________. ________________ ___ _______---------._-,------------._-_-_____... _____________________________________________________________ ._ __ .. _________ ________________________________________________________________________________ _ __________________________ _________________________________________________ ________ ~________..____________----__.____.____ I hereby c .'fy that I hav prepared this ap icatian and that the work will be done in accordance with San Joaquin County ordinances, a aw and an r ulations of t " San Joaquin Local Health District. (Signed)--- - ( r Contractor) 1 4�;----. ------------------------- -=------------ ------------- -------------(Title)-------------------- ----- -------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- --------------------- -------------- DATE-------------- -- REVIEWED BY----------------------------------------------- --- --------- ----�5-�-------------------------------- ---------- - ------------ DATE--- ------- -�---------------�------------- BUILDINGPERMIT ISSUED-------------------------------------------------------- --------------------------------------------- DATE----------------------------------------------------------- Alterationsand/or recommendations:---------- -----=--- --------------- ----------------------I----------------------------. -------- ------•--•--------------_--------------------------- --------------------- ------------------------------ ------------------------- -------------------------•---- -------------------------------•- --------------------------------------------...------------------------- ------------ -------------------------- -------------•-------------- ------ ----------------------•--------------------------------------.---------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------- ---------------------------------------------- ----------------------•.------------•-------•-"------------------•-•---.-------- --------------------------- ---------------------------------------•---•------------- ------------•----•----------------------------------- FINAL. INSPECTION BY:. ------------------------------------------------------------ Date------ ---------1-- ----------- ----------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT r 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy. California k1 ES-9-2M 145446 ATWCCD 12-5a