7614 - Laserfiche WebLink

Home Browse Search

SANITATION PERMIT Permit No. .- �-- -- � , �'. APPLICATION FOR 5A J ,k (Complete in Duplicate) Date Issued A plica{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 wit County OGdinanc No. 549. ________________________________ n ----•-------------______ ------------ JOB ADDRESS A LOC ION.- -------- . . V ----- -- ---------------------- - _ Phone.--------•----------------------- t ------------- . - --------------------- Owner's Name -- --------___----------_______........._-------------------_-----------_------------------------------------ Address._.- ------ ---- ---------•• Contractor's Name--- ------- ---------------------------- ------------------- Phone__........-•------------, Installation will serve: Residence Apartment House ❑ Commercial [3 Trailer Court ❑ Motel ❑ Ortherr❑ „� ---- :Lot size } t Number of living units: __�____ Number of bedrooms .- _-._ Number o baths . i .047 : Public system El Community system ❑, Private D Water'Supplyepth to Water Table --------- ft. Character of soil.+o a depth of 3 feet: Sand;❑ Gravel ❑ Sandy Loam 0 Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ previous Application Made: Yes ❑ No New Construction: Yes yNo ❑ A 1 TYPE OF INSTALLATION AND SPECIFICATIONS; ` (No septic tank or cesspool permittedYIA, isewer is available within 200 feet T 1 fA _ ..Mate i .1 - Septic Tank: Distance from nearest w -_____Distan e frfa�sndat'son__.- __.No. of compartments_____ `_-5ize_ 4+ -_._: Liquid d#pth__._ - --�_. - Capacity_ 1 Distance from foundation__-__ __.._-...Distance to nearest Io line, -- -Dispos l Field: Distance fromnearest.w _. Width of trenc ____._ ------Number of lines.____-..-- -- -„Length of each line_____- ---- FType of filter materFal._:_ Depth of filter matenai- ._ -�-----Total length_____...____- -- ------------ , . t 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__._-.-._----------------"-""--gals. _ r I --------- Liquid Capacity---------------- ❑ Size: Diameter---------------------------- --:-Depth -_= f== g \ Priv Distance from nearest well-__._..___- ------Distance from nearest building------------------------------------------- Privy:- -------------- -------- El Distance to nearestaot' ine:_-__-__--------------------------- - -------------•------------ }-- ----- ------- T ' ------ ----------------------------------------------------------------------- pas4iRemoderg and'/or re ( e --- -- ------------------------ --- -- +------ --------- L: 1 hereby certify this application and that the�wo ertify that I have prk will be done in accordance with San Joaquin County ordinances, t laws, and rules and regulations of the San Joaquin Local Health District. \ - ` - _ -----------------(Owner and/or Contractor) - ( 0 ------------------- --------------------. ` -------•---(Title)-......... By:-------•----------_-- (Plot plan, showing size of 10#, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY t ----- ----------- DATE , ------ APPLICATION ACCEPTED BY ------------------ -------- --------------- ------------: . REVIEWED BY-------------=----------------- -- .. _ - - - DATE---- . - ------- ----- DATE-------- --- BUILDINGPERMIT ISSUED--------------------------------------------------=--------- ----------- --------------- Alterations and/or recommends#ions:__---_------------__:,__..__-----_.......... ------•------------------ - -- --------------------------------------•--- ---------------•----•---- ------ `� y FINAL INSPECTION BY:..- -------------------------=--------- Date---- --7--- `� =-�� ------ -------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C” Street i30 South Americas Street Trac California Stockton. California Lodi, California Manteca, California y E5--4 145446 ATWOOO