4423 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. r (Complete in Duplicate) Date Issued _z-_-_�'/J;� '\ lica+ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. his application is made in compliance with County Ordinance No, 549. JOB ADDRESS AND LOCATION---- /-, --------- 'Q' -------------------------------------------------------- Owner's Name-------------------------------------- --- fr1 -L1'_ Phone --- Address--------------------•- • `L � i -------------------------------------------- -------------------•-------------•------------------------ Contractor's Name------------------------------ � ------------------------------ Phone------ Installation will serve: Residence 0( Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __ _- Number of bedrooms !Number of baths ---!-- Lot size ------ -Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeK Hardpan ❑ Previous Application Made: Yes ❑ No g New Construction: Yes ❑ No ❑ "�� .454#451,1,U TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) T46 Distance from nearest well_________________Distance from foundation-------------------Material------------------------------------------------- 0itic, - No. of compartments------ -------------------size----------------------------•---Liquid depth--------------------------Capacity----------r- Disposal Field: Distance from nearest well d. -.--Distance from foundation_,PQ r--____.Distance to nearest lot line. ________ Length of each line_ ___oS- .-_-----------Width of trench_ 'K`�`__.__._______.__.. Number of lines________________ _ g a Type of filter material ___1IL_AM.....Depth of filter ma _.......-Total length------------- �..�__.------------ Seepage Pit: 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------------------------------------- F1 _._____________ --_____.____________❑ Size: Diameter-------------------------- -----------Depth----------------------------- ----------------------Liquid Capacity- --------------------------gals. Privy: Distance from nearest well------- -----------------------------------------Distance from nearest building--------------------------------------- ❑ Distance to nearest lot line---------------------------------------------------------------------------------------------------------------------------------------------- Remodelingand/or repairing (describe)----------- --------------------------- --------------------------------------------------------- -•--•----------------•--------•-----•------------------- -----------•--------------------------•----------------------•--------------------------------------•------------------------•-------------------------------------------------------------------------- -------------------------------------------•-------------•---•-------------•-•--------------------------------------------------------------------------------------------- --------------- --------------- ------------- -----------------------------•---------------------------------------------------------------------------------- ----------------- I hereby ce ify at I have pre ared Anis application and that the work will be done in accordance with San Joaquin County ordinances a laws and ules an regulations of the San Joaquin Local Health District. (Signed) -------- ---- _ Contractor) By-------------------------------------------------------------------- (Title) +�. �---------- (Plot plan, showing size of lot, location of system m r ati n to wells, buil gs, etc., can be placed on reverse side). OR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----. - -`---------- DATE---------- ------------------- REVIEWED BY--------------------------------------------------------- ------------------------------------- ------------------ DATE------------------------------------------------------------ a PERMITISSUED------------------------------------------------------------------------------ ••---- DATE---------------------------- Alterationsand/or recommendations------------------ ------------------- -------- ---------••------------•-•------------•---------------------•-•------------------------------------------------ -------•----------•----------------------------------------------------------------------------------------------------------------------------------------------- ------- ------------------••------------------------- --------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------•------------------------•-•--------------- -------------------------------------------- ----------------------•----- ----•-- ---- --- ----------------- ------------------------------------------------------------------------------ 43 FINAL INSPECTION BY--------------------- • ' --.----- Date-----_.[. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street 4 Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 10-52 Revised W-2100