7333 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued ---- . ___ S� Applica{ion 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 compliance with County Ordinance No. 549, , ' f a .r �r�. - ------------- JOB ADDRESS AND CATION________ - ---- ------------------ -------- �. t q: Phone------------------------------------ Owne�'s Name_ -- p - -------- --- - ------------------------•----•----------•-------------•- ------------------ --------------------------------------....... Address.---------1-6---7� ----------- i Contractor's Name----- -__ r Installation will serve: Residence j4---Apartment House F1Commercial ❑ Trailer Court E] Motel E] Other [Ii F Number of living units: /----- Number of bedrooms _ Number of bdfhs _/___ Lot size _d----- --- - -------------------------- Water Supply: Public system .Community system El'. Private ❑ .Depth to'Water Table _ 0 ft. Character of,soil to a depth of 3 feet: Sand ❑ Gravel F1 Sandy�Loam E] Clay Loan; [I ,Clay ElAdobeQ Hardpan E] Previous Application Made: Yes ❑ No 0--- New Construction: Yes Q No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ° �Fr4 � (No septic tank or cesspool permitted if public sewer is available within 200 feekfi.) Septic Tank: ' ' istance from nearest well_________________Distance from foundation=__________________.Materia______..______________.___________.-_.______:_._. 4 ❑ of compartments------ - ----------------Size_-------------------------------Liquid depth--------------_----------Capacity----------------------- Disposal Field: 'Di tance from nearest well_________________Distance from foundation______..___________.Distance to nearest lot line________.____..." ❑ u er of lines----- --------------------------- 'Length of each line--------------------------------Width,of trench-•--------------------------------- F Y II T �Dpepth of filter material-------------- -------Total length----------------•-------------- I K T e or filter material____- _= a,.-•� ... t Distance to nearest lot iine___fa_�__" Seepage Pit: _Distance to nearest.we iatan i eter------ r/ De A---�.1?--------------- R1 ------- . Q Number of its-----i_ Lining mate ial:C9---=--- p ` Cesspool: Distance from nearest well----------- from dation___ Lining material____-_.___________------------"---- De th -'--------------------- ------Liquid Capacity----------------------------gals. ❑ Size: Diameter-------------------------- --------- P Priv Distance from nearest well_.___-------------------------------------------Distance from nearest building-----..._____-_______-------- ---- Y:t -------------------------------------- El --- Distance to nearest lot line"'----------------------�-�--------- ---------•--- �W •-------------------•------------------•-----•-- _ ------- Remodeling and/or repairing (describe___________________._:'._______-__ _r 3 I ' -- s I hereby certif t.l have prepared this application and that +he work will be done in accordance with San Joaquin County J ordinances, 5t aws and rules and regulations of the'San Joaquin Local Health District. _ and/or { ) ran / r Contract ' ------- :""-------------• - "----- (Signed)----- � Y: La (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 ' 4 APPLICATION ACCEPTED BY------ ----------------------- - DATE DATE-------•--------- ��- ------••-----• ----------------- REVIEW-ED $Y ' = DATE ------::�-------------------------- BUILDINGPERMIT ISSUED---------------------------------- ---------- ------------•----------------•- I Alterations and/or recomm_ tions: " '._ fit -' ---------------•----_-- •----•- ------- 5------J--.�-- �- ---- ------------•----------- ----------------------------------------- { :_._ --- - Date_ FI AL INSPECTION BY------ ------- ----------- SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C" Street 130 South American Street Tracy, California Stockton, California Lodi, California Manteca, California y i E5-9-2M Revised,W-2100