5579 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit Novf`.".. '.� (Complete in Duplicate) - Date Issued Applica+ion is ereby made to the San aaaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND L ATI0V--------- --1-----=4 ------ "' ------------------ ------- e Owner'sNam_a-- _--4- •- - - �� f1 - ,�-- ----- Phone_f '.c ------ al Address _�- - Q �.. W: - ----- v ---------- Contractor's =Contractor's Name_-_f .c� • Phvne - Installation will serve: Residence A artment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ z. Number of living units: 1__-_ umber of bedrooms J--_ Number of baths ---Z_ Lot size ___/7nz ---------------------------------- Wafer ______________________________Water Supply: Public system ❑ Community system F] Privatex Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ Nox New Construction: Yesx No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: r I (No septic tank or cesspool permitted if public sewer is available within 200 feet.) fi Septic Tank: Distance from nearest well_ -- ______Distance from foundation__AP----------Ma Material T -� � __ ___:. ------------ A No. of compartments........ ----------------Size--c�?, + -_ / --:---Liquid depth-- -- .- -----Capacity---_��- o al Field: Distance from nearest well_�e__ ...Distance from foundation_,/Q__- _-: .Distance to nearest lot)ine_ -�_______ t Number of lines------------ ------------- Length of each line______.�f2_______ _ -__.Width oftrench.___� - __ ____--_-_.____.________ Type of filter material_ _ __ ______ _ _____Depth of filter material---f_?___...........Total length--------. 7- .-______________--____ Seepage Pitz' Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line-___-__._________ ❑ Number of pits.-.-----.------------Lining material----------------- -----Size: Diameter-------------------------Dept h------.-----_-------------------- Cesspool: Distance from nearest well----------_------Distance from foundation--------------------Lining material__.._-_-_-_.---_._________________-_. ❑ Size: Diameter--------------------------------------Depth----------------------------- ----------------------Liquid Capacity----------------------------gal, Privy: Distance from rearest well---_----------------------------------------------Distance from nearest building---__________.________-________.______._. ❑ Distance to nearest lot line Remodeling and/or repairId ng (describe] Z - ---------------------------•-------------•------------------------------•----------------------••-------------- ------------------------------------::-------------------------------------------------------------------------•------------------------------------------------------------•-------•----••---------------------------- I hereby certify-that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat laws,'and : les and regulations of the San Joaquin Local Health District. a , {Si ned - ------------------------------------------------------------ Owner and 9 ]------ ---- -----:- ;----; _. _ - .and/or Contractor] By:-----------------X=" 4-fl, ---1= ---------------------------------------------- - --- ---- - - - --------- Title e;7,-e t �/F'7- (Plot plan, showingfsize of lot, location of system in relation to wells, buildings, etc., can be pace on revers sde� FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------------- -- ---------------------- -------------------------------•----- DATE------•. REVIEWED BY------ •------------ -------------- DATE"----- :�----- --- - - ---------------------------- - BUILDING PERMIT ISSUED. --- - ---- - - ------------------------------------------------------------- DATE-------------- ---- ------------------------------------ Alterations and/or recommendations---------------------------- ---------------__--------------------------------------------------------------------------------• -------------------- ----------------------------------------------------------------- ------ - --------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------- ----------------------------------------------------------------------- -------------------------------------------------------------•----------------------------------•-------- - ----- FINAL-INSPECTION BY:................ ---------------------------------------- Date-------------o--- \ - - --- ---------------------------•--•----- 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 ES-9-2M � Revised W-2100