7555 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. _.-- ---5 (Complete in Duplicate) Date Issued Application is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. ,(� JOB ADDRESS AND LOCATION-47-�b "" ------/x----------- -------- •--------------------•----------------------••--------------- Owner's Name_______________ _ ��---- ��'0 '�---- Phone Address------------------ ----- - - ------------------- - - �`- ---------------------•--- Contractor's Namerr�� ------------c - - e`� , t - c Phone//P_ .�p _. Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ____.Number of bedrooms __2-_-'N-umber 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 ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑, No Ian New Construction: Yes ❑ No ®� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) „I Septic T nk: Distance from nearest W&Iv�� --------Distanc from foundation_�__�>____�____-Material_._____..._-_"--- - �__________ I No. of compartments_ ................Size_s3t 4F from k.q _ Liquid depth__nj---- _ ______Ca acit 4_149 � 610 Oil Disposal eld: Distance from nearest well Distance from foundation---�_P_�____ .......Distance to nearest lot line____.________ Number of lines------ � Length of each line___�.0_��_.____._.Width of trench_.aZ_ I`._ ______________ Type of filter material_ pth of filter rriaterial_1.�----___-------Total length-___,' _:-______________.__-- 01 See a e rt: Distance to nearest well Distanc fro foundation---/_..____._..Distance oto nearest I t line----2_� p g Number of pits....�---------------Lmmg material�r Size. Diameter ---------Dep tn.. _________________________ Cesspool: Distance from nearest wefl-----------------Distance from foundation-- Lining material---___-_..____.._.____.______________- ❑ Size: Diameter------ --- ---- --- ----- ----- Depth---------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------- -----------------------------Distance from nearest building------------------------------------------ ElDistance to nearest lot line-- --- --- -----------------------=----_--._.-.---------------------------------------------------------------- Remodeling and/or repairing (describ --------------- s ~ = -- ----- '” 1__------�•--�--� ----------- j9_1 -•--=-•-- k . - ----- ------- ------------------- - _ -_ ____:_:k-: _.-________________-__------________:____::___-_-__-::__,________-__--_:__._- __---_._-:___:-_--__-----___-_________--_-:_____-- 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)------------- ------------------ --••----------------------------------------------------- ---)SN ----- ---- - - •- ---------- . Contracforj By:---- {Title) C�"""� - ----------- (Plot plan, showing size of lot, location of system in -relation tobuildings, etc., can be placed on reverse s' ell. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------------------- - --- - - --------------------------------------------------- DATE------------- ---------------- REVIEWEDBY------------------------------------------------------- ---------- -------------------- ---------------------------------- DATE------ --- BllILDINGPERMIT ISSUED --------- ------------------------------------- DATE..- -------------------------------------------------------- Alterationsand/or recommendations--------------------- ------- --- - ---- ----- ------------------------------------------------------••----------•---------------- --------------------------- ---------------------------_1-- -----------•----------------------------------------•------ -----------•----------------------------------•-----------------•---------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ - --•----------------•---••---------------------------•---- ------------------------------------- --------- ---------------------------------------------------------•------------------------------------------------------- ------------------------- ------ ---------- ------------------------------------------------------------- --------------------------------------•- ---------------------------------•-----------------------•--------•-- FINAL INSPECTION BY:.- Date --....... - '----- SAN JOAQUIN LOCAL HEALTH DISTRICT $ t 130 South American Street 300 West 6ak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 145446 ATWPgo 72.54