5149 - Laserfiche WebLink

Home Browse Search

-7 APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued Application is hereby made"fo, the San Joaquin Local Health District for a permit to construct and install the work here* described. This application is M!L(IP in compliance ith County Ordinance No. 549. '242 ju --- .. — ",'uuV2_ JOB ADDRESS _6A�Nj'P6 O TION ,� - ----AIL"ell1v--- -------- - ------- Owner's Name------- ------------------------ --------------------------------------------------------- Phone_ ---------- Phone---Address----------RI - -------- �----- ------ .......................... Contractor's Name... /_ ----------------------------------- ---------------------------------------------------- Phone Installation will serve: Residence Apartment ❑House E] Commercial ❑E] ❑Trailer Court E] Motel Other El L Number_of living-unifi: --')L Number of bedrooms _V___ [I Number of baths I—' -Lof'size --- ---------------- -Water Supply: Public sysfem 0` Community system E] Private Depth to W6fer Table Character of soil to a depfh'of 3 feet: Sand [I Gravel [] Sandy Loam E] Clay Loam E]I Clay ❑ Adobe Hardpan L] Previous Application Made: iiYes El No New Construction: Yes El No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) V, Septic Tank-' ante from nearest well___-_-__________Distance from foundation-------------------Material of compartments-- -------------------- A Size------------ --------------Liquid depth------------------------._Capacity---------------------- Disposal e from nearest well-oK--------. +Disfance from foundation--/--O---'-----,Distan-ce to nearest lot line___ M er of lines-Z�---I------------� j;---- ----�ength of each line------1-�&S----------Width of trench �_ ------------- filter material___..9'T-)-#-CApfh of filter material--------JS------Total length.____ - - --------------------- ewType or page Pit: Distance to nearest welf- -------------------Dista'nce 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---------------------- —------r--------------Liqu;d Capacity---------------------------gals. Privy: Distanceilfrorn nearest well__- ---------- El Distance,to nearest lot line--------------------------------------------------------------------------------Distance from nearest building---------- ------------------------------- --------------------------------------------------------------------------- ------I------- ---- Remodelingand/or repairing (describe]____________________---------------------------------------------11-------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------I----- ------•-------------------------- I----------------------------------------------------------------------------------------------------------- - -- -----------------•-------•------ ------- ----------------------------------------------------------------I----------------------------------------------------------------*------------------------------------ -1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, av rules and regulations of the San Joaquin Local Health District. (Signed)----------- ------- -----------------------------------------------------------------------------------(Owner and/or Contractor) By:--------------- - ------- ----------- ... .... .... (Plot plan, showing size-ze.of lot'- -_----------------------------- -----------------------------------------------------------(Title) location ---------------------------------------------------------------- of-system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ------------------ APPLICATION ACCEPTED BY--------- --- ------ --- --- -- DATE REVIEWED-BY----- ------Ili;---------------------------- ------------------- ------------ -- -- DATE _ ---------------------- -- - ---- ----------------------------- ------ BUILDING PERMIT ISSUED----=----------- --------------------------- DATE---._---......... Alterations and/or recommendations ........ recommendations — -------------------------------------- --------------------------------------- -------------------------------------------------------A--------------------------------------------- ---------------------------------------------------------------- ------------ ---------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------- -------------------------------------------------- ---------------------------------------------j------- ------------- ---------------------------------- --------------------------------------------------------------------------------------------------------- - ----------------------------------------------- ---- ----------------------------------------------------- ----------- ------------------------------------------------I--------- �c------------------------ FINAL INSPECTION BY ------- ---------------------------------------------- Date-------------5? ii SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Sfreof 300 Wes+ Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 10-52 Revised W-2100ii