4076 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicated 6 VA'spfication is hereby made to the San Joaquin Local Health District for Date Issued _____-/d 1,�3application is made in compliance wi}h County Ordinance No. 549, a permit to construct and install the work herein described. JOB ADDRESS AN LOCATION._-.-------d wner's Name ' ---------•- ------ ------ ----------- •- ------------------------- ----- ----- Phone._�_".y0-""q 2 ." Address .---- - an rector's Name------------ -" " --- -------- _ ----- ---------- ---- ------ ------- qqss Installation will serve Residence ------- ------- - -------- ------------ -------------------------------- Phone-,l-__-� �Q,7 �'Apartment House --'"""- "----'-""-- ❑ Commercial ❑ Trailer Cour} ❑ Motel ❑ Other ❑ Number of living units: _ -_ Number of bedrooms -_ a�- Number of baths Lot size ____lr� 0 � Water Supply: Publics stem X �f-�--- ---"-•_-- ____ Y ❑ Community system ❑ Private �pth to Water Table _/Q ft. Character,of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobeardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes ❑ No Lam' 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__-----.__......... ❑�v No. of compartments..----- Size Material------------------------------------------------- f Liquid depth ------Capacity-----------------------� Disp�osa/l 1=field; Distance from nearest well------------ pistanco from foundation""--__-"" _r E Number of lines " "-�.......... Len th of each"line-""_--__ /� "-----Distance to nearest lot line.__��_ -"- g dp� Width of french_--_-v2 ff v Type of filter matariaL._/� ___Depth of filter material__----/- --- ----,Total length-------_--T_41-�------------------- Seepage Pit: Distance to nearest'wel)------------_---------Distance from foundation_--______ ❑ Number ofpits__""_-----------------Lining material-_-_-_-"_-.--_-_ "-"•---Distance to nearest lot line___------------- Cess Cesspool, Size: Diameter"_ P Distance from nearest well----------------- Depth________________"_""-- Dis}ante from foundation--------__-__--""_,Lining material_"___"_______ Size: Diameter------ --------------------------- ----- ------------ ---Depth--------------------------------------- - -- ----- Liquid Capacity- --------------------------gals: Privy; D7 stance_from nearest well-------------------------------------------------- Distance from nearest buildin ❑ Distance to nearest lot line g ----------_--_"_"_-_ ------------------- -- Remodeling and/or repairing (describe)--------------------------- ----------------- f---------------•-------- - ----- • - ------ -----• ----- ------ -•-- -- - ------- -- ---- ------- ----- ------------------------------------------ --------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Jaaq uin County ordinances, State laws, and rules and regulations f the San Joaquin Local Heal 4 th District. (Signed)------- .s�1C� ------------• --• --------------------------------------- ----------- ------- BY� -------•----------------•--------------•- T and/or Contractor (Plot plan. showing size.of lot. location of system in relation to wells, buildings, etc., can be platen reverse side). 1 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY" ----- ------------------------------------ -------------------------------------- REVfEWED BY_"_" _"""__"- _ DATF �__,------------------------------------------------ ---------- _" 8UILDING PERMIT ISSUED--------------------------------------------------------------------------------------------------------- - DATE--- ""_ -------•-------------------- -------------- Alterations and/or recommenda+ions:_----____-- DATE--------- -- -- ------ - -- - FINAL INSPECTION BY--___-____--" --. ...__ •- ... , Date- - --- ------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street Stockton, California Eodi, California 132 Sycamore Sfreet 814 North "C" Street Manteca. California Tracy, California ES-9-2M 10.52 Revised W-2100