7835 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. .._. _......____ (Complete in Duplicate) Date issued /3l Applita+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. JOB ADDRESS AND LOCATION....... � -----------�i---- -- _ J '��-------------------------------- ----------------------------------- -- ---- - - -- Owner's Name-------------- �---��-;_-__-- •-------------------------- -- -----'---------------- ---- Phone--- -- -•----....---•---•---- --- Address-- •- ---- - Contractor's Name ' F4 rd .�- ..:.__.:. Phon -��j6J Installation will serve: Rei nce Apartment House ❑ Commercial ❑ Trailef Court ❑ Motel ❑ Other ❑ Number of living units: ----__._ Number.of bedrooms ______.: Number of baths 7,Lot size -----------_________________________________________________ Water Supply: Public system ❑ Community system-[] ''Private ❑ Depth to'Wates Table-___=___ ft: Character of soil to acdepth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ "Adobe �ardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes ❑ No ❑�� .. . TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.)Sf� ; ti_c T nk: Distance from nearest well-----------------Distance from foundation------------'......Material________......r---__-._-__________.._.---__.--. No. of compartments., coin artmeints------------ ----------- -Size-------•------------------------Liquid de th___-------.---- -_-.,.,-Capacity ------ ---------------- . osaId: Distance from nearest-well_-- .Distance from foundation____________°.------Distance to nearest lot line_________________ Number of lines----------------------------------Length of-each line-------------__-----:_-----.Width of frenck-------------------------------- i Type of filter material-__________________...._Depth of filter material____..-------.--------Total length------------------------------------------ p rt: Distance to nearest well__ti_L�_ '____Distanceom foundafion__:f _.___,__..Distance to near 11�11ine Number of pits..'- --------------Lining material__ _._ >.__.Size: Diameter_-- .Vii___-.=.Dept '..- _-- Cesspool: Distance from nearest well-----------------Distance from foundation._.._._...-.____'__.Lining material------________.____________.________ Q Size: Diameter--------------------------------------Depth---------_------------- -------- - ------_Liquid Capacity ----`--•-gals. t • . .4 ii. P tY == Privy: Distance from nearest well------__--------------------_-----_______________Distance from nearest building.,___._._____.______________.._____-___. ❑ Distance to nearest lot line f :. .,, M --- ----------- ---- - - - ----------- 7. -r Remodeling and/or repairing (describe):---------_....................................... -----------•..............................•---•------------------------------------------- ---•------•----•---------•----•------------•-•- --•----------••-------------=--------....------_--.. -..-------------------- iF s F ------------------------------------ -----------------------------•-----------------------------------------•----------•---•-------•---•---•----------------------••------------------ ------------------------ 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. f DAY&NIGHT (Signed).... f ---------------Septic-Tank_S_erVir_0------------------------- -------- ------ -- Contractor] r 1206 So.Eldorado HO 2-7046 ------------------------- tBY: ------------------ - - -- - Title .. . -- ----------- . --- ---------- (Plot pian, showing size of lot, location of system in relatio t wells, buildings, tc., can be placed on reverse side). FOR DEPARTMENT USE ONLY , APPLICATION'ACCEPTED BY--------------------------- ------- ------------------------------------------------------------- DATE----- REVIEWED BY DATE = ` - -•------•--- --•------- BUILDING PERMIT ISSUED------------------------ -- ------ DATE..---------- . . Alterations and/or recommendations:------------ - -------- -----------------------•-------------------------- --=-------------------= ---------•--------------------- ----------'----------------------------- ---- -- - --- --- ------- ---------------------------------------------------------------------- - - `� -..................... ------------------------- -----r•- ----- - - ---- - - _ __ --------=---------------------- --------= ----------- � ---------------------- ----- - ----- -------------- ------------- ------- ---- ------------ ---- ----------------------------------------------------------- ...... r _ �.. FINAL INSPECTION BY: - Date 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 745446 ATWppD 12-54