8198 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. -_4 •—........ (Complete in Duplicate) Date Issued ---------------------- Applicalion 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 with County Ordinance No. 544. JOB ADDRESS AND LOCATION---------- ---------------------------------------------------- Owner's Name........ � _ r--__•� --- Phone i* `----------------------- -------------- ---------- Address------......4-aw --------•-----------------------------------------•------------ J Contractor's Name-------------- -_--_ o�--_------- - - --------- - -----------------------• ----------------------•---- Phone----------------------------------- A VE Installation will serve: Residence Apartment House ❑ Commercial E] Trailer Court [-] Motel E] Other, ❑ t W , Number of living units: __ ':- Number of bedrooms ' ._ Number of baths .. .. Lot size --- ��-_r• f ' ___.._____--___-- Water Supply: Public system Community system ❑ Private ❑ "Depth to Water"Table Y,1—ft. Character of soil to a depth of 3 feet:, Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe [}� Hdpan " ❑ Previous Application Made: Yes No pp ❑ �'-New Construction: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: p (No septic tank or cesspool permitted if public sewer is available within 200 feet.) epti-,Tank: Distance from nearest well_________________Distance from foundation------------.-------Material -_____'--------------______.._____--________-. � No, of compartments------------------------ --•---Liquid depth.------------ . Size------•-------- -------- - Capacity------------•---------- �` i r i� scT�l d: Distance from nearest wellIL-01"X-"Distance from foundation_ _ _r_...-----Distance to nearest lot line._ __ == Number of lines-------- ---------------------- ,-'Length of each line--- -`--------------- trench------ _ Type of filter maferial_ -JCDepfh of filter material.__ r.-__'-.7ota! length__r_ ------------------------ Seepage Pit: Distance to nearest well_�•�?_•��_Distance from foundation__�,_.�_____ Distance to nearest lot line--- __ \ [}" Number of pits__.__.-----------Lining materiald6'_ a.� ize: Diameter.._,�.r.............:Depth___ _------------- Cesspool: Distance from nearest well_________________Distance from foundation-------_-........... Lining material--------------------____.._________._. ❑ Size: Diameter------ ---------------------------- -Depth------------------ -------- ---;------ -{--4---._Liquid Capacity------------ •--------gals. I Privy: Distance from nearest well--------------------------___-__.-_--._._..__._Distance from nearest building ❑ Distance to nearest lot line....... --------------------- -------------------------------------------------------- ------------- / repairing �r Remodel in an or re airin describe --------------------- ------___- ---- - r_ •------------ --------------------------------------------------- ----------------------••----- -------------------------------- _,•- .: ------------------------------••---------------------------------- I hereby certify that I have prepared this application and that the work will be done in-accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Locol Health District. - (Signed)_ 6 By:----------------- '� - ------(Title)_,By: ) (Plot plan, showing size of lot, 1. ion of system in relation to wells, buildings, etc:;-can .be placed on reverse ' e). F FOR DEPARTMENT USE ONLY +. APPLICATION ACCEPTED BY -------- =' DATE._= -�.; ,.----------- ---------•----------------------- REVIEWED BY-------------------------- -------- ---------- DATE---6` ••---•---•---'----- - BUILD]NG PERMIT ISSUED ----------- ---•-•--------------------- - ----U --------- ----"•-•--------------- DATE..-- U` Alterations and/or recommendations:----.----------- - "� �------------------ ----------- t ------ -----•-•-------------------------•------•-------•-------------- ---- --- -✓ y f l - --- ---------- •-...� .------------------ .............................--••-•---------------•--••------- -------- -----•---------- ------- •--------------------------------- ---------------------------- --------------------------••----------•------ k FINAL INSPECTION BY:... ------------- --------- Date:. '-� 4 SAN JOAQUIWLOCAL HEALTH'DISTRICT 130 South American Stree+ im, 300 West Oak Street 132 Sycamore Street 014 North_'C" Street Stockton, California Lodi, California Manteca, California Tracy, California t ES-9 345446 ATWaoo