14122 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE. Permit No. ---�------ �. -- APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) - Date Issued _-----•- •-- -----•- This Permit Expires 1 Year From Date Issued 1' 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 corinpliance with County Ordinance No. 549. 1 ------••-----••--------------------•-------•-- -----•----•----•----•---•--•--•---••--•-•......••. . JOB ADDRESS AND LOCA ION.-.../ - /�.--��-:"'= --•-•---• -- - Phone-------------•-------------------- Owner s Name..:.--- - --•- -------•---- ------------ /� ----------------------------- Contractor's Name---------- li•------------- � --------•---------..--------------------. -•---- ----------.------------_--------• Phone..-----------------•--•--•-•--•---- Ili Motel ❑ Other ❑ Installation will serve: Residence [A--Apartment House ❑ Comillmercial ❑ Trailer Court ❑ Number of living units: .__.__ Number of bedrooms _ - Number of baths _.�---- Lot size _•..___..-- ./_...-------•--•------ Water Supply: Public system [ Community system ❑ Private ❑ Depth to Water Table � ft. Adobe Hardpan Character of soil to a do thIf 3 feet: Sand ❑ Gravel ❑ Sandy Loam❑ Clay Loam ❑ Clay ❑ EI' Hardpan Application Made: (If yes,date-----------------___7 No R" New Construction: Yes ®' No ❑ FNA/VA: Yes E] No [Z TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septi an)C: Distanc4from.,nearest,well___------------__Distance_from_foundation.-------------------Material__............................................... No. of compartments Size -••------------ Liquid depth--------------------------Capacity.. Disposal Fey: Distance f rom nearest well. --.-_Distance from foundation.._I d__...___...Distance to nearest lot line ............... . i x,99 Number�of-lines---.--- .��^ ----------------Length of each line----._ -©_`y------ Width of trench..------- y--`•------------.. Type of filter material. 45<� (_.----Depth of filter material_.-1-r ____--�-----Total length.__.r_. _ 4�.......••-•••---•-----••••- Seepage Pit: Distance;to nearest well :?� -------Distance from foundation..-_,(.P_.--------Distance to neaiest lot P111, Numberi of pits____--.__I..________Lining material_ AC-t----•Size: Diameter_3.3_j'_.___--- Depth------------:!&4 I. Cesspool: Distance from nearest well_________________Distance from foundation_...__..,___-_!___.Lining material..-._____---_,..____--..--...--_-- Size: Diameter. ------Depth_..-•--------------------•-------------------------Liquid Capacity----------------------------gals. Privy: Distanceh from nearest well------------------------------- -------------------------------------------------Distance from nearest building-----__________________•---____..___-__._. d' -- --------------• ------•-- ❑ Distance to nearest lot line-----------•--------------= ----------- ---•-----•-----•------••-----••---•-••---- _._ Remodeling and/or repairing (describe):-----•--- --------------------------- --=----------------•---------•---------------- ........ i�� ---------------------------------------------------••--------------------. -•-------------------- ------------ -------- -------------•----------•-•-----------••- Ili ----------- -- ------------------•----------• ----------- ----------------- ----------------------------------------- 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 regulatio of a San Joaquin Local Health District. 5i nod - ---- --------- -------------•---------------- ----------------[Owner and/or Contractor) Title - { ) (Plot plan, showing size of let, location o system in relation to wells, buildings, etc., can be placed on reverse side). .�U R DEPARTMENT USE ONLY di APPLICATION ACCEPTED BY 4 Imo - DATE -------------------- APPLICATION REVIEWED By-------- ---------------- DATE BUILDING PERMIT ISSUED ---------------------------------------------------- ---—--------•-------- DATE-------------------------------------------- •---•-•-------•-••---- ------•---••--------------•------------- Alterations and/or recom iii�en: dations-------------•------------------------------------------------------------------------------ ------- ------------------- 'I�I -------- ---••-----------------------11------•----------•----•- .. -•-------- M1" L' ____________________________________________________________________ ______ _______________________________ FINAL INSPECTION BYII:.__-. �1 Date .-= .� - .,� il4 SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American S1reef 300 West Oak Street 124 Sycamore Street 305 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California Es 9 REVISED 6.89 7M 6-61 Alt-AS