3152 - Laserfiche WebLink

Home Browse Search

--.5- APPLICATION FOR SANITATION PERMIT Pe it No.G' - 1 (Complete in Duplicate) Date issued--------./ Ap�licafion is hereby made to the San Joaquin Local Health District fora phrmit to construct and install the work herein de ribed. This application is made in compliance with County Ordinance No. 549. - JOB ADDRESS AN *ATION-------- ------- R = Z—F -------------------------------------- T"'L' Owner's Name------ = -- - Phone-- -- Address---------- -- --------------- ---� -- --- ------------••----------------•------------------------------------•------------------------------------ 0 Contractor's arae-------- ------- --- - ------------------- ---------------------------------------- Phone--- Installation will serve: Resi ce Apartment House ❑ Commercial ❑ Trailer- Court ❑ Motel ❑ Other ❑ . Number of living units: _-_____ Number of bedrooms_ Number of baths -_l__ Lot size __SG X- r ------------------------ Water Supply: Public system Community system [IPrivate E] Depth to Water,TableaZ.r ft. Character of soil to a depth of 3 feet: Sand Gravel E] Sandy Loam El Clay Loam E] Clay ❑ Adobe ]�Hardpan ❑ Previous Application Made: Yes ❑ NOX 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------------------------- Capacity----------------------- Disposal Fie : Distance from nearest well--------------- .Distance from foundation--------------------Distance to nearest lot line_.____--__._____ ,171'V Number of lines-----------------------------------Length of each line-----------------------------Width of trench--------------------•-------------- 7/ r-/ Type of filter material-------------------------Depth of filter material-----------------------Total length--------------------•--------------------- Cv/ 1 *'l See age Pit: Distance to nearest well_�r ._Distance f om_f ndation_ __.______.Dist entre #o nearest lot li If ---------------- Number of pits----- �------------Lining material�� --.Size: iamet ----------------- `'� Cesspool: Distance. from nearest welk-----------------Distance from foundation------------------_Lining material------------------------------______.. F1 � Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid ---------------- -------- ----------Depth----------------------------------------------------Liquid Capacity----------------------------- g Privy: Distance from nearest well--------------------------------------------------Distance from nearest building------------------------------------------ ❑ Distance to nearest lot line--- ------------ -------------- ----- emod g and/ repairing (describe)__________ --' --- f ____ ________________________ __ __________ _ __`__ _ -____.____ ______-___. ------------ __ __________ ___________ ____________ ____________ ____________________---___________________________- ______________________________-___..__._-._____..__________-______________- ____ __ I here_by cerci that I have prepared this applic tion and that the work will-be one in accordance with San Joaquin County f% F ordinances, Stat- a s, and r s d regulations of the San: Joaquin Local Health District. (Signed) ------- - --- ---------------------------------------------------------- -(Owner /or Contractor) - '-{------�--------------------------------------------------------------------------- --------(Titl (Plot plan, showing a of lot, location of system in relation to wells, buildings, etc., can be plat on reverse side}. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED-BY--------------------- - ------ DATE------------ REVIEWED BY---------------------------------- ------------ - ------ DATE------------------------------------------------------------- V ----- - ------------------------------------------------ -------------------------------------------------- BUILDINGPERMIT ISSUED----------------------------- ------------------------ - DATE----------------------- ----'-------------------------------- Alterafions and/or recommendatisuns-------------------- --------- ------------------------------------•-----------------------------.------------------- ---------------------------------------- ------------------------------------------ ------------------------I----------- - - FINAL INSPECTION BY: _.------------------------- --- ----- Date , � SAN JOAQUIN LOCAL HEALTH DISTRICT f. 130 South American Street 300 West Oak Sfreet 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES--9-2M 8-51 Revised W-2100