4738 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. ----- ` (Complete in Duplicafe] Date Issued I........... -S3 Applicaa-ion 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 Ordi ante No. 549. JOB ADDRESS AND LOC TION-_ _ _/ fI_ ----- ---------1 --------------------- wner's Name--------- ,•-- � Q ._- •-- ------- - - -- Phone-- Address--------------- � -- - ---- - .- ` ---- ------------- Contractor's Name----------- -------- --�_�,_� _ �'' « Phone T6.0 ------------------------•--------- Installation will serve: Residence � Apartmenf House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __.� Number of bedrooms - ._ Number of baths ----/ Lot size _�O'__/r_� � �/ ------ Water Supply: Public system �ommuni+y system ❑ Private ❑ Depth to Water Table _= ft. Character of soil to a depfh of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loa -[3Clay ❑ Adobe ard Hpan ❑ Previous Application Made: Yes ❑ No [g,""'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 Field: Distance from.nearest well-----------------Distance from foundation--------------------Distance to nearest lot line El - :,Number of lines- -------------------------- (� --------Length of each line-----------------------------.Width of trench Type of filter material-------------------------Depth of filter material-----------------------Total length-----------•---••------- :- • a� Seepa e it: Distance to nearest w II_---___- --_--Distance fr m oun anon---_ d.,�,:.Distance to nearest lot line-_�,_ / /i [t �'f -�7 Number of pits.__----_ --_____ Linin material-C.. �r g Size: Diameter ---- Depth-_.-- ,to----i Cesspool: Distance from nearest well`-------------- Distance from foundation.-____-.- - ----.Lining material------ ---------- ----•---------- ❑ Size: Diameter-----�--------------------------------Depth--"---:----- I ------Liquid CapacitY----•-----------•----------gals. Privy: Distance from nearest well------------------ '----------------------------Distance from nearest building.-,__-.-____.-__---___- ❑ Distance to nearest lot line__________ ________ a 1 - } Remodeling and/or repairing (describe)--------- ------- ---- -- ----------- -----------•------------------------------•--••----------•-- --------------•--------------- --------------------------------------•------- -•-•-------•----•------•---------------------....------------------•--------•----------------------------------------------•-------------------•--------------------- 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:regulafions of the San Joaquin Local Health District. (Signed)--------------------C ` -- ----- ! �a�n�/oContracfor] By: - (Tifle)- ----- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). l FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED 13Y •- �t� r --- -- DATEQ _.. REVIEWED BY ------------------------------ ----- DATE -- --F---,- - -----•------------ ILDING PERMIT ISSUE=D-_. ---------------------------------------- --------------------------------------.. DATE Alterations and/or recommendations-— ----------------- -------------------------•------- -... i ---------------------------- ----•----- ------- ------------------ - ---•------••-•--•--•------ FINAL INSPECTION BY:__---..-. r ----------- Date.-._ -------- ---- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Sheat t'300 West Oak Street 132 Sycamore Street ,814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California 4 � 6Sy9-2M Revised W-2100