2982 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. . --�' (Complete in Duplicate) DateDate Issued ----- -____-- Application is hereby made to the San Joaquin Local Health Disi-rict for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No, 544.. JOB ADDRESS AND LOCATION--------17661 ��P�T �T�9'�.EC ,, r --"'� ----- -- ------- AJ /i ------------------------------------------ Phone-------- - Owner's Name---- ------=---------- -- -- ��•------------c! �-- -�--�--� - �._rci_l/ --------- Address------------------------------ G--- Contractor's Name------------------------------------------ -loe!r'----------------- --------------------------- Phone----------------------------------- Installation will serve: Residence a' Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel i❑ Other ❑ Number of living units- -------- Number of bedrooms ---Z- Number of baths __1---- Lot size ---_-------9_-7___- _�_ ------------------ Water -- --_ Water Supply: Public system ( Community system '❑ + Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 2� Hardpan ❑ Previous Application Made: Yes ❑ No Jk New Construction: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septictic Tank: Distance nearest well---'-- an foundation---- /------Ma#eria __- - - -------N--- --- ----- Noof compartmentsX _ qp ---------- ---. py----- - - -- ------. DiI Field: Distance from nearest well-- -----Distance from foundation___-_P�0........Distance to nearest lot line-_-_--.„7�. Number of•lines------- Length of each line--------------------_-------.Width of french---_-----___-_-�.l__o_if______ Type of filter material-1 ,"{- L_Depth of filter material----------f ------ --_Total length----------------L ZQ-'----____---- Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line--------___-----_ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter------------------------Depth--------------------------------- Cesspool• Distance from nearest well-----------------Distance from foundation--------------------Lining material__-----_-_----_-------------__-_-___-. ❑ Size: Diameter-------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals' Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-------------------.-_-_--_--_----------. ❑ Distance to nearest lot line---------------=---.-------------------------------------------------------------------------------------------------------------------- , Remodeling and/or repairing (describe)-------------------------------------------------------------------------------------------- - -------------------------------------•--------•--------------------------------------------------------------------------*I--------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------•---------------------------------•-•--------------------------- -------------------------------------- '1 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)--------------------- -------------------- - -------------- (Owner and/or Contractor) -------- -------------- ------ -- BY: ------------------- Title ----- ----- - --------------------- (Plot plan, s � g size of lot, location o ystem in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT.USE ONLY � tl APPLICATION ACCEPTED BY------------- --------------------------------------------------------------------- DATE-- ------ Y ------------------ R EV I EW ED BY /4-"` `= --------------------------- DATE------------ BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE p Alterationsand/or recommendations---------------------------------------------------------------------------------------------------------------------------------------------------=----------- ""-"--------------------------------------------------------------------------------------------'--------------------------------------------------------------------••----_-----------------------f_____--•__-_• 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, Californid' .,'' Manteca, California Tracy, California E5-9-2M.,861 Revised W-2100