5401 - Laserfiche WebLink

Home Browse Search

�-- APPLICATION FOR SANITATION PERMIT Permit No. _- _p-.`_ (Complete in Duplicate .. � Date issued7"_�-'3'`•�_ 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. ' " -t^-! -_---------- �----------------- /� JOB ADDRESS AND LOCATION-- -- ----/�y/_f�---�i� `-- -C -----1 .. '------------------------- Owner's Name ---- - -------- ---^_-'----------- - ------------- -------- - Phon�-4_-__S�`_��.. Address----------- --�--• - -- •- -- -- ----�"�-°- ---------------------------------•--------------------------.__.... Contractor's Name- t -------------------------------------------------------------------------- Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --/---- Number of bedrooms _.Z_ Number of baths J--- Lot size sG__0 ----_.--_---------------------- Water Supply: Public system ❑ Community system ❑ Private �epth 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 P New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: 04 k (No septic tank or cesspool permitted if public sewer is vailable within 200 fe tj i Septic Tank: Distance from nearest well_--__---_______Distance from foundation-----1a---__---Material- : -_____ p-__-_-.----¢�-_ff No. of compartments-------S-------------Size�.._Y�_-Z34-_-Liquid depth.--�.---------------Capacity----l!__a ./ ' Disposal-Field: Distance from nearest w�jll_______________-Distance from foundation---_�--"-_.--Distance to nearest lot line---- -__-- dNumber of lines- ----- Length of each line-----------4p_#_ _"{'_.Width of trench-.-1 — --___-___.________._ W Type of filter material_ /-c2--- ....Depth of filter material------J-F-.........Total length___.-.--/P__Q.---.'01'----------------- W Seepage-.Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----------------- F1 ,Number of_pits------------------- material-----------------------Size: Diameter------------------- ---Depth-- -------------------------- Cesspool: Distance from nearest well' ._ .___-_Distance from foundation-------------------Lining material__-..----.----..---.----.-_ ------- ❑ Size: Diameter---------=----------------------------Depth---- T-------•------------------ .------ --._Liquid Capacity------------------------ gals! Privy::, Distance from nearest well-------------------------------------------------Distance from"nearest building-------------------------.-- Distance to nearest lot line---------------------- ---------------------- - --------------------------------------- ------------------------------ - Remodeling and/or repairing (describe)------------------------------ f x -" 4 . -----------•------------------------- -------------------------•-----••---------------------------------------------------------------------------•-------•----`-------------•------------•------------------------------ 5 - 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) - < r and/or Contractor - ------------------------ y: .----$ --- ---------------------------- ------ (Plot lilan, 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-, ,.-----' Y = ------------------------------ DATE REVIEWED BY------------------------------------ -------- --- - - --�----------- -- - --------------------- ------------------------------------------ DATE-- •----••----- ...-- ---------••-------------••---•--•- - BUILDING PERMIT ISSUED--=--------------------------- -- ------- DATE---------------------- - -------•-------- Alterations and/or recommendations--------------- ---_--.-- ----------------- - ---------------------------------------------------------------------------...- -------------------------------•---•-----------•--•-•------••-•--------•-----------------------------------------------------------------------------------------------------------------••-•---•------------------•-- ----------------------------•-----•---•--------------.-...------------------------------------------------ -------------------------.---------- -----•--------.. ------ --------------------.-..__..-------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------ s � r� FINAL INSPECTION BY:-------------r'---8�.--------- ------------ Date--- ---------F--1- - -.w-- ---T - !t-.------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" S+r Stockton, California Lodi, California Manteca, California Tracy, California t` ES-9-2M Revised W-2160