7407 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) /q/�jj r Date Issued Applica+ion 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 Or inance No. 549. -------------------- --- -- ------- JOB ADDRESS AND LOCATION------ .......... ----- ------------------ -- - ---------- ---- ------------- -- ----------- Owner's Nam - ----- ---------- - - ------ - ---- -- -------------------- -- ----------------------------- ----- ---- Phone- ------ - ------------------ Contractor's ----------------------- --------------------------------------------------7....-1--------------------------------------- Address-------- - ------------------- Contractor's Name------ ---------------------------------------------------------------------------------------------------------------- Phone---------------------------------- Installation will serve: R.,'id�. c. Apartment House E] Commercial E] Trailer Court E] Motel El Other D Number of living units: --i---- Number of bedrooms -:7:> Number of baths .1.----- Lot size ---Qom,-------------------------- Water ---- - ------------------------- Water Supply: Public system F1 Community system El Private Depth to Water Talole7v- ft. Character of soil to a depth of 3 feet: Sand-D Gravel E] Sandy Loam)( Clay Loam El Clay El Adobe[] Hardpan El Previous Application Made: Yes [] No 9 New Construction: YesNo El TYPE OF INSTALLATION AND SPECIFICATIONS: I (No septic tank or cesspool permitted if public sewer is available within 1 200 feet.) Septic Tank: Distance from nearest well--- --------Distance from foundation--------------------Material---------------------------------- -------------- IJ No. of compartments-------------------- - --Size---------------------------------Liquid depth--------------------------Capdcity..------------------7- Disposal Held: Distance from nearest well-----------------Distance,from foundation--------------------Distance to nearest lot line--_--_--__-_-.--. ❑ Number ine----------------- Number of lines-----------------------------------Length of.each line----*-------------------------Width of french----------------------------------- Type of filter material------------------.-.-----Depth of filter material--------.-..--.-------.Total length------------------------------------------ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line.-------.----_--_ ' ❑` ine----------------- El' Number of pits---------------------Lining material----------------------.Size: Diameter-----------------------Depth--------------.-----_--- -------- Cesspool: Distancefrom m n eq.,X, fro . ..... fi rest well___.,S��___Disfance froQ_foijndaf ion--- maferial Sizec�o _fals. -1 -600,e r "Iq 0, Liquid Car)acty-.,. Dep Privy: Distance from nearest well__#� ---------------------------------------Distance from nearest building--------_--_-.--_-----.---._--..----.----. ❑ uilding---------------------------------------- DDistance to nearest lot line-------- --------- - - ------ ------- ........ --------------- ------------------------------------------------------------------------- Remodeling and/or repairing (describe)=-- -------- --------- ------ ----------------------------------------------- --------------- _t ------------------------------------------------------------------------------------------- ------------------------------------------------------------- _r- ------------------------------ -------------------------- ------------------------ -------------- ----------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------I---------------------------------------------------------------------------------------------------- ---------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. Ilk, N_ or Contractor (Signed)----- ---- -- --------------------------------- --------------- -------------------(Owner and/ By:-- ------------------------------------------- ----------------------------- ------------------------------------------------------(Title)-------------------------------------------------------------- (Plot plan, r sowing owing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----__--------------------- ---- -----------------\---------------------------- DATE - -------------- ......_0.-- ----------------- REVIEWEDBY--------------------------------- -------------------------- DATE------4 BUILDING PERMIT ISSUEDDATE----------------------------------------------- -- ---------------- DATE----------------------------------------------------- -------------- Alterationsand/or recommendations: -------------------- ---------------------------------------------------------------- ------------------------------------------- ------------------------------------------ ------- -------------------------- - ----------------------- -------------------------------------------------------- ---------- - ------------------------------------------------ ------------------------------------------------------------------------ - ---------------------- --------------------------------------------------------- ------------------------------------------------------------- > ----------------------- -------------------------I---------------------- ------------------------------------------------------ ---------------- ------------------------------ ---------------------------- --------------------------------------7------- ------------------------- - ------------ -------- ----- ------------ -- -------------------- ------------------------------------------------------------------- D - —-------Z6— ---_---------------- - --------- FINAL INSPECTION BY---- ------ /-------------- ------------------- ate----------W--------- -- 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 145446 ATWCDt2-54 11PIK.