3617 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit Nom_/_r___-_ (Complete in Duplicate) Date Issued 14/13/_153__r3/_153 Application 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 compliant it Cp#my Ordinancgylo,549. ��3 ►� � r --- -------------•-- kc J08 ADDRESS AiGJk� L ATION--- - .• --'- ------------------- " Owner's N e l = = •--------- :. _.. --- -------- -- - - -•- -------- -- ----------------------------------------- Phone.......` r4�*3 a Address----- '---1.. `.. .--••-- ---------- ---- - .Q Contractor's Name--- -----•-- ---------- ------------••-------------- --------------------------- Phone----------------------- ------ Installation will serve: Residence El Apartment House WCommercial Trailer Court ❑ M el ❑ Other ❑ Number of living units: Z_ Number of bedrooms .Z__ Num�tepfh baths _Z__ Lot size __ __ -- ------------------------------------- Water Supply: Public system E] Community system E] Private to Water Table _______ ft. Character of soil to a depth of 3 fee . Sand ❑ Gravel ❑ Sandy Loam f Clay Loam Clay [❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes V No� New Construction: Yes [►No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public Sewer is available within 200 feet. f Septi Tank: pistance from nearest well y.____ Distance from foundation--'7L&_ ______Material______________________________________________. Op f No. of compartments----------------------f-Size--------------------------------Liqu /d�ep,th--------------------------Capacity------------------ ! 4 A6 W Disposal H I Distance from nearest w 11 .._Distance from foundation____ _v_ Distance to nearest lot lin _ dr Number of lines__________- _ tt t -------- �---1 ._ _-_ _-_ Length of each line------___-�. _ tf__--.Width of trench.____-_ _-- -�--------------- 7ype of filter materi � ,, /Depth of filter material___.___ 1__._____Total length_________.____ _____________________ rn Seepage Pit; Distance to nearest well----------------------Distance from foundation___.___.-___...._._.Distance to nearest lot line----------------- , ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------_-_.--Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-__.____________________.__.______ ❑ Size: Diameter----- ------------ -------------------Depth--------------------------------------------------.-Liquid Capacity- ---------------- - --------gals. Privy: Distance from nearest well_____________________________________________ __Distance from nearest building-.---------__.__________--___..._____..._. ❑ Distance to nearest lot line------------------------------------------------------------------•-------------------------------------------- —XI Remodelingand/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 regulations of the San Joaquin Local Health District. (Signed)O;irffi ' ---------------------•-------------------------------------------------------------------------------------(Owner and/or Contractor) By:---------------------•---•--•-------------------------------------------------------------------------•---------------------------(Title)---------------------------------------------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed'on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED B'0_2i . - DATEV- ------------------------------------------------- -- REVIEWEDBY----------------------------- -- - --------------------------------------- DATE--- -----------------•-------------------•------------ BUILDING PERMIT ISSUED------ DATE. Alterations and/or recommendations:------------------------------------------------ --------------------------------• -------------------------------------_--------------------_------------ ---------- -----------------------------------------------------------------------------------------------------------•----------------------------------------- •---------•---------------------------••-------------•----- -------------- -------- ---------------------------------------------------------------------------------�---------------------------------------•----------------------------------------------------------•---------- a FINAL INSPECTION BY:. `a'`-/--•--• Date--------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stock+on, California Lodi, California Manteca, California Tracy, California ES-9-2M 10-52 Revised W-2100