2777 - Laserfiche WebLink

Home Browse Search

l . �j APPLICATION FOR SANITATION PERMIT � Permit No. (Complete in Duplicate) Date Issued -------- ____________-_ _____- Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work rein described.�n �jhisapplicafion is made-in-compliance with County Ordinance No. 549. 04, 0.?o-3 1 .. r --------------- JOB ADDRESS AND LOCATION ---------- ----------------------- __----- � S _ p . • �"�� "�` Owner's Name -------------- -• ------------ Address... ---------- --------------------------------- 7-------- Address----------------------••---------------------------------------- _ --- ----- -------•------------------------------------------------ ---------------------------------------------- Contractor's Name. c �:_ _ fir-+- - ------Y- ----------------1----------- Installation ---------Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court 1 Motel ❑ ❑ Other ❑ Number of living units: _ Number of bedrooms /__ I � --- �-_- Number of baths __ ___ Lot size ___ T Water Supply: Public system ❑ Community system ❑ Private 0 Depth to Wafer Table ft. � Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam [-] Clay Loam ❑ lClay ElAdobe �' Hardpan E]Previoas'Application Made: Yes--E]- NoY❑,'�-New Construction: Yes ❑- No E] - m-, TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Ta k: Distance from nearest well_________________Distance from foundation--------------------Material ___-________ �-7 No. of compartments--------------------------Size--------------------------------Liquid depth--------------------------Capacity �osaall Feld: Distance from nearest well________-'------Distance from foundation--------------------Distance to nearest lot line---------------- Number of lines----------------------------------Length of each line------------------------------Width of trench----- Type of filter material---------------___-------Depth of filter material-----------------------Total length--------------------------__---- _______-__ --------------------- Seepage Pit: Distance to nearest� well_fQ'p-'"____Distance fr fo nda �_r tion_--I _ istance to nearest lot line__Number of pits__:'______________Lining materiae---Size: Diameter---------.Depth------�:�.�------------------- Cesspool: Distance from nearest well-----------------Distance from foundation-----------.--------Lining material__________-____-________-___-___-____. aIs Privy❑• Distance fromnearestne est well -Depth te r.- -=- .-�_-�� -'.p_c,t-;- -i- �� T' � ; Distance from nearesfbudding------------------------------------------- Distance ___________________Distance to nearest lot line____________________________ Remodeling and/or repairing (describe):___________________ -----•-------------------•--•---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ! hereby certify that I have-prepared this application and that the work will be done in accordance with San Joaquin Count' ordinances St la , nd'rules an ulations of th San Jo ocaalth Distric. $ Signed) � ` 4 . = ----- r C nfi�actof) --.� --- --e ------------- -- -- - - ---------(Title)-----�- ---� - -�`--��' !�---- --- l (Plot pia ; saw' size of lot, location of syst m in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------- ------ -- DATE--------------- --- --- --------------------------------------------------------- -- --- ---------------- REVIEWED BY---------------------------------------------- ---------------------- ------------- - -------------- DATE------ -- -----�------�-�---=�-------- ---------------------------------- - ----------- UILDING PERMIT ISSUED -------------------------------------------------------- -------------- DATE ---------------- A aerations and/or recommendations ----------------------•----------------------------------------- -------- ----------------------------- ----•-------------------------------------- ------------------ ------------------------------------------------------- -•---------------------------------- ------=---------------- •------------------ ---------------------- ------------ - -- ------------------------------------ FINAL INSPECTION B ----- --- Date- -------- /---- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 Soufh American Street } 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockfon, California Lodi, California Manteca, California Tracy, California E5-9-2M 8-51 Revised W-2100