4778 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. �- -_ T_. _ (Complete in Duplicate) I I _r'' . �. ..- Date lss ed --- ----- 43.E..mer Application is hereby made to the San Joaquin Local Health District for a permit to construct a d e k herein described. This application is made in compliance with County Ordina e No. 9. � JOB ADDRESS A LOCATI N_ Owner's Name - ------------- --------------- ------------ r Phone- '" Address09 0 ---------- °' --------------------------------------------- W__1% Contractor's Name------ -------------------------------------------------------------------------------------------------- Phone_ _ Installation will serve: Residence JW Apartment House ❑ Commercial ❑ _Trailer Court ❑ Motel ❑ O:ther Number of living units: __ ____ Number of bedrooms _ Number of-.baths __ . Lot size____._ -__ - . --- Water Supply: Public system ❑ Community system ❑' Private Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy LoamClay Loam E14 Clay ❑ Adobe ❑'. Hardpan [jPrevious Application Made: Yes E] No New Construction: Yes , TYPE OF INSTALLATION AND SPECIFICATIONS: (No sep+ic tank or cesspool permitted if public sewer is available within 200 feet:) r e Septic Tank: Distance from`nearest,.welL'__ __ ------Distance from foundation__ Material. _ Liuidde .th ----------- --.. a► -? SNo. of compartments_ pacity-__,__-r^"�--------- /`� /� I- r Disposal Field: Distance from nearest well--��- --_Distance from foundation__ ___V _____,,D<IS ante to nearest'lot�l�e.��______ Number of lines------/----------------- -----Length of each line_ ---------- Width of trench Type of filter material _ __ _____ _ ______Depth of filter material_/_ __�._____kTotal leng]h ----" ---------- ------------ WIP Seepage Pit: Distance to nearest well----------------------Distance from foundation----------------.!".Distance to nearest lot line------------------ 0 Number of pits----------------------lining material-----------------------Size: Diameter__¢ ------ ----Depth---------._____------------------ t Cesspool: Distance from nearest well-----------------Distance from foundation..___.--------------Lining material------------------------------------ ❑ Size: Diameter----------- - - ----------Depth----------------------------------------------------Liquid Capacity-----------------------:---gals. ..: . r -61_-------------_.-Distance from nearest building_____________ "'�"Privy:-•��^"-� Distance from nearest well---- �------------------------- ----------------',------ _- ❑ Distance to nearest lof'line------------------------------------------------- ------------------- -------- ------------------------------------------------------ Remodeling ---------=--`---------------------- --- Remodeling a d/or repairin (describe):_ � _-� _ 4_ ter ___„_- ------- -------•-.h --- --- ----------------- ------------------------ ----•-- ------------------------..-•---- -- --------------- '--_ _.-_;;i_�% __ __r ______ ________• »_-______--_ _.________-_ _.-____----___. -_-____-_-_ __ ----------------------_____________ireb------------- ____________........... _______________________________________»..-..___-____-___--_-_-.._--_--_-_--__--_-----_----_&--------.---------.-----------------.-------------------- _-_-----.__ I , y certify that.{ have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State w) and Aanregulafions of the San Joaquin Local Health District. ! y1 (Signed) - -z °'C-C'"--------------------------------------=--- -#----- --._Owner and or Contractor) By:----------------- - -----�r- ----------------------------------------------------------` (Ti+le�_ I f —�---:. -- -----e (Plot plan, showing size bP [(of, loca+on of system in relation to wells, buildings, efc., can'be plac d on reverse 1d6). OR PMENT USE ONLY . r ” APPLICATION ACCEPTED BY------------------------ ------------------------..-.-------------- DATE----- REVIEWEDBY--------------------------------------------------- ------------- ----------------------------------------------------------- DATE------------------- BUILDING PERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE:` - ' Alterations and/or recommendations---------------------------- -- --------------------------------------------------------......------.--------------------------------------------------------------------------------------------------------------.._..------------- ---•-•-'----------------------------------------_..-.--------•----•---------------------------------.._._.-..------------------`-------------------------------- - -.---.------_------------------------------------------------ - --•-------------------------------•-------------__---•-a- ------ . FINAL INSPECTION BY:.----- ------ Date----- ----ltl -11-.--------------------� 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 E5-9-2M Revised W-2100