5310 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION ERMIT Permit No_ ____________ _ (Complete in Duplicate) _ Da+e Issued Applica4ion 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. 55449. JOB ADDRESS A LOCATION........ -c� '�-- � �'Y L' 5 �1I .----- ----------' 1a -------- lc5-0Y�- 1 Phone Owner's Name-- -=�----------------------- Address----------------------------------------------------- ---- ---------------------------------------------------- --------- ---- _-- ------------••---- Phort � a-�f_ . Contractor's Name......•------------------ u�.� l.t� - --------r�""-�-��---------•-•--------------•---------•-• - / Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: __Number of bedrooms _-L. - Number of baths _-�.-_ Lot size _-___(6�-��r--i•x"-�- - 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* Hardpan El Previous Application Made: Yes ❑ No)4, New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 240 feet.) �� -__Dista e from foundation_ Q._______--.Material____ _________ __ Septic Tank: Distance #rom nearesr well w �� No. of compartments-�--_--------------Size _1R-j4_.--�--Liquid depth-AWS--- - Capaci+y__/oPt'_j+_• ire of Disposal Field: Distance from nearest well_ou -Distance from foundati ..f '__.._Distance to nearest lot line____._ Number of lint, ------ Length of each line_ :-"' .Width of trench.P _ ��__________________ DD Type of filter material________-_ _n - _Depth of filter material-__r_O__.j-_.__..Total length--__ -____________________ Seepa ePit: Distance to nearest well__js`r r-_Distance fr foundation__ __..Distance to nearest lot-line----- Linin material-- -- --- - - Depth -4 r Number of pits------__-�-- g �__Size: Diameter-_--_-- z__ ------ - ---- --------------- Cesspool: Distance from nearest well----------------- from foundation--------------------Lining material------------------------------------- -- ------Depth----------------------------------- ----------Liquid Capacity.-----------•---------------gals. ❑ Size: Diameter_____._______________ __ Privy: Distance from nearest well..-----------------------------------------------Distance from nearest building________--__________--______._--___.___. ❑ Distance to nearest lot line-------------------- -------------------------------------------•----------------------------------- --------------------------------------- Rem Jelin d/or repairing {describe): 4AI l " "� '- -------------------------------------------------------- AJ -. - ----------------------- ------------------- ----------------------------------•---------------------------------•--•------------------------------ -------••----------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, ate ws, and rules5aregulafions of the San Joaquin Local Health District. ----------- Contractor) (Signed]-----•---- --�� -------- ------- - ---------- - -- -�----- -------------------------------------------------- --------- By:...._ ---------------(Titleys 1 - a `'------- ------------------ (Plot plan, showing size of lot, location of syste n reiafion to 4ells, buildings, etc., can be.placed on reverse side). FOR DEPARTMENT USE ONLY /J DATE --------- - APPLICATION ACCEPTED BY-------------------------- �/� -- REVIEWEDBY------------------------------------------------------------------ ----------------------------------------------------------- DATE------------------------------- •--------------------------- BUILDINGPERMIT ISSUED------------------------------------------------ --------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations-------------------- --•- -------•-----------------••----------------------------------------------------•--------------- ---------- ---------------------------------------------------•-------- -•--------------------------- ------------------------------------ Date------------- f "'� FINAL INSPECTION BY: fese. - ----- /-- ---- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 Soafh American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California MantecwrCalifgrnia Tracy, California ES-9-2M Revised W-2100 t