3807 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. ---- (Complete in Duplicate) Date Issued L� Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the wc7t:;Zjrrein described. This application is made in compliance with County Ordinance No. 549. ADDRESS AND LOCATION...._I�t-k� : __ _QQ _.__1hi_ _ .I�----A �f-- � ' �1`--------------------------------------------- JOB ___ ------- Owner's Name------------------------------------- --- -- -------- ---------- �hl'�tS C-x R/�'ll- ----------------------- Phone Address ------ -1-r1•-F--•------------------ ------•-----------•--------------------------••---------- ------------------------------------------ ---- ---- _ Phone------q-:f _Contractor's Name--------------------------------�AA�d--`��- - -------- -� -�-------------------------------------- Installation will serve: Residence X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: 4--- Number of bedrooms -X.. Number of baths ---/-- Lot size __c ----- ---� --•-------------- Water Supply: Public system (g Community system ❑ Private ❑ Depth to Water Table 4oft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe X Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes ❑ No ❑0j,oe41;wy TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) S tic T. Distance from nearest well---------------- Distance from foundation--._____-______.___.Material_..____.________ ___..______._._______..____. dhk. No. of compar#ments_______________________ --------------------------------'�iquid depth--:Distance to nearest lot line----------------- I ------------ � �. -SizeCapacity------- ------- Disposal field: Distance from nearest well_________________Distance from found ,, Number of lines------------------------------------Cengfh of each line------------------------------Width of trench..-.------------------- Type o1 filter ma#erial-------------------------Depth of filter material-----------------------Total length------------------------------------------ Seepage Pit: Distance to nearest well- -� -_-_Distance fr foundation__ �__-.___.Distance to nearest lot line___------- Number of pits.------1-------------Lining ma 4---Size: Diameter- 3 -��-- --Depth--- ��-------------• f Cesspool: Distance from nearest well---__-_-__----__Distance from foundation---------------_--.Lining material------------------------------------- El ___-.-.-_-------__._-._- _--._ ❑ Size: Diameter. ---- ------Depth----------------------------------------------------Liquid Capacity- ----------------gals. I Priv Distance from nearest well-__----- ----------- -----_----Distance from nearest building-------._-_------._-----__--.-- _--___. Y -------------- Distance to nearest lot line ------------ ----- --- - ------------ - ------------------------ - Remodeling and/or repairing (describe ------------------------ ----------------------------------------------------- ---------- -------- - -------- --------- ----------------------------------------------------------------------------------------------------------------------------------•--------------------I----- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, to laws, and rules nd regulations of the San Joaquin Local Health District. ractor (Signed]----- �. --- -------- --------------------------------------- ----- Cont ) By:------------- ------------------(Tit _.} le) .s. (Plot plan, showing size of lot, location of system in r ation to wells, buil in s, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- - DATE--it::'-------------------------------------------------- ------------- BY---------------------------- ---- ------ ------ ------- ----- --------- ------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE l� Al+erations and/or recommendations---------------- ----------- ------••----------•-------------•------•--------------------------- ------------- ----- = � ----- -- ------ ----------- FINAL INSPECTION BY:.......... ----•---- --------- Date.._------- �j/ "I " -------------------------------------------------- SAN --------------- -----------_--_------ ---------SAN JOAQUIN LOCAL HEALTH DISTRICT Sycamore Street 814 North "C" Street {30 South American Street 300 West Oak Street 132 S Y Lodi, California Manteca, California Tracy, California Stockton, California , ES-4-2M 10-52 Revised W-2100 _.