2183 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. ------------ (Complete in Duplicate) Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install-the work herein described. This application is made in compliance wifh ounty Ordinance No. 549. JOB ADDRESS AND LOCATION----- ..... ��' -------------------- Phone__� Owner's Name............-------------------------��'M----- F---------- -------- - ----------- - -----------•---- -------------------------------------- --------- -- Address.....---_---------------- - --------------�" �� ' _,74b - q - --------- Contractor's Name----------------------- A-e.__r ---JL__ 2L�f_S_ � ./ Phone--•- --�" Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __A___ Number of bedrooms 1----- Number of baths Lot sizeC7 - -------- Water Supply: Public system 0 Community system -El Private [IDepth to Water Table_yft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe U' Hardpan ❑ Previous Application Made: Yes ❑ No;A- New Construction: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if yublic sewer is available within 200 fet.) Q --.Material---- --- ------ ----- ----------- Septic Tank: Distance from nearest well_ �N_1,,--Distance from foun afion_19_____.____ _ f�x _.Li uid de th__; _er______ Capacity No, of compartments__----------------- Sizef ` Disposal Field: Distance from nearest well------------------Distance from foundation--------------------Distance to nearest lot line_________________ ❑ Number of lines-----------------------------------Length of each line------------------------------Width of trench-------------------------- Type of filter material------..--jj-----------------Depth of filter material---------____-- -------Total length------------------------------------ f Pit: Distance to nearest well__I4� ______--Distant fro fo ndation__�f_ ------Din�e to nearest 10t-line- _______. Lining materia y- ---Size: Diameter---- ---- -- ----------De Depth- -- ----------------- Number of pits______I____ - "1- _ p Cesspool. Distance from nearest well-----------------Distance from foundation___-_____---___-_-Lining material_____- _______..______..� El ---Size: Diameter----------------------------- ---Depth----------------------------------------------------Liquid Capacity- _---------------------.-gals. -- --------------------------------------Distance from nearest building----------------------------------------- Privy: Distance from nearest well---------- i ❑ Distance to nearest I li Remodeling and/or repairing (describe):__- -•--`'-----------------------------------•--- -------------------------------------------------------------------------------- ------ ---- ------- ----- -- I hereby certify that have repared this applicati that the work will be done in accordance with San Joaquin County ordinances, e I , a and re lations of t e an Joaquk-Leval-Wealth District. St t - Contractor (Signed} .. - a r -------------(Title) '* d ' Y� f --- ----- --- (Piot plan, sho n size of lot, location of s e in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ` DATE NACCEPTED BY- REVIEWED $Y----------------------- ---- - ---------------- DATE ----------- I BUILDING PERMIT ISSUED-------------------------------------------------------- DATE --------------------------- ------------------------------------------------------------------------------- Alteratio sand/or recommendafions:__-___---_-------------------------- --------- - - - -� = ------- -- '�`-----------------------------=------ �+--v�. ------ -------------------------------- -------------------------------------------- --------------- FINAL INSPECTION BY:-------- ---------------------- Date I 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 6 ES-4-2M 8-51 Revised W-2100