5521 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. .,.E_•.? ! _--- (Complete in Duplicate) �--�/ .. Date Issued Applica-ion is (ereby made'to the San Joaquin Local Health District for a permit to construct and install tFie work herein described. This application is made in compliance,,with County Ordinance No. 549. AV JOB ADDRESS AND LOBATION_____ `__ --Y' -------------------------- -------- "`! �f"- -- Name '_,_ r `-�__ _ --•------ _..-. �.. Vis` Phone'- _ '�G—-------- Owner's ' Address--.....2A.12 -- -- - !l_ , 'Contractor's Name---- ---- -------- -- `----------------------------------------------------------------------------------------------------------- Phone----------------------------------- Installation will serve: Residence [ Apartment House ❑ Commercial [j Trailer Court ❑� ,Mot I L] O er [� Number of living units: --t�----- Number of bedrooms .-- Number of,baths .- ---- Lot size .---_ _� ----- -------- Wafer ---Water Supply: Publics stem Community system Private �De th t 'Water Table -------- ft. PP Y� Y ❑ Y Y ❑ p Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam (Clay'L'oa'm F] Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No W New Construction: Yes [�/No ❑ s r TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if pu6Uc sewer� available within 200 feet.) + Septic Tank: Distance from nearest well„�' ._..___ Distar�ce from Ffou tion__ _ _ __.Mater'alf_._ ---------- If --- __ -�R _Li uid de th_�._.-_ .-- - _- --,-._- No, of compartments___________ _____t___.__S¢ q p, __-__-_Capacity.. . r Dispos Field: Distance from nearest weI __---_.Distance fr m foundation_�.V `€?is-ence to nearest 19t V � Number of lines---._._-.�____ __________ ____Length of each line-------4� Width of trench________ Type of filter mater�tal,.�'1._ Depth of filter matenal..-_..� _--------Tota] length___________�- --- ----------------- �+ ._ 1!� .Seepage .Pit: Distance #o nearest well---------------_------Distance from foundation--------------------Distance-#o nearest lot Eno_______..___.___. -Linin material___--- '..__:.._.Size: Diameter___-__--__ ❑ Number of pits-------------------- 9� '� -- ---------.Depth--------------------------------- Cesspool: Distance from nearest well_-_-.___,____-'Distance from foundation--------------- material__------_-_-------_.--------__-_----_. '•- F ' i ------------------------------------- F_ _1k_ -,.__ ..__Size.: Diiameter.:..�; --.r= � Dept.h------------ = _ _ _. : . _ Li.quid_Capacity----_--------------------gals. _ Privy: Distance from nearest well.--.---_-._--_y--.-_- ____------Distance from nearest building------------------------------------------- E] ------------------------------ ------ ❑ Distance to nearest lot line ----------------- ---- --•--- ------------------- Remodeling and/or repairing (describe)---------------- - -------=---------------------------------------------------------------------- — '--------------------------------------------------------------------------------------------------------------------------- _ , 1 l ) = ---------------------------- -- I hereby certify that I have prepared this application and fihat�`thde`work will be done in accordance with San Joaquin County ordinances, State laws,:and rules and regulations of the:San Joaquin Local Health District. y r -----(S' ned) I_ _— {Owner and/or Contractor `1 - By:----------------------------------------------------------------- -- --� - -------------------------------------------Title ' [Piot 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.BY.. -;�-�___ --.--------------.-_-. _�_ ---------- DATE REVIEWEDBY-------------------------- ----------------------------------------------------------•- ----------=----------- DATE-- --------------------------..........--------- BUILDING PERMITISSUED......-------•-----------------------------------------------------------------------•--------------• DATE-------- 5R�w----•••-• ---------- Alterationsand/or recommend ations----------------------------------,---------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------- -----------------------------------------------11------------------------- -------------------------------------------------------------------•--•--------------------------------- --------------- -----------------------------------------------•----------------------------------------------- E t/ Date `5 FINAL INSPECTION BY:---'--------------` v^ ,_= SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES---9-2M Revised W-2100 .• I