9732 - Laserfiche WebLink

Home Browse Search

'd APPLICATION FOR SANITATION PERMIT Permit No. (Complete in in Duplicated y j Date issued ---�----..`/_�__-Ir Application is hereby made to the San Joaquin Local Health District for a permit to canstruct and install tlfe work herein described. This application-is„made in.compliance�=ith-Cour;ty Ordinance No. 549. JOB ADDRESS AND LO ATION_--- --------�� --- +� �•_--- _--- -----:-------- ---��'1'v--C-!- ------------------- ------�l -- Owner's NameT Phone --------------- ------------------------------------------------- Address1 -------------- •------------------- •----.---------------•------- - ----- - 4 Contractor's Name = Phone.. ---------------- -------- ----- ------ Installa+ion will serve: Residence Apartment ouse ❑y, C/ommercial ❑` Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _)-_-- Number of bedrooms _'V Numbe of baths ----L Lot size -------h- --------------------------- Water Supply: Public system El Community system ❑' Private'l Depth to Water Table?-6_- ft: Character of soil to a depth of 3 feet: Sand Gravel ❑ .Sandy Loam` Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan El Previous Application Made: Yes ❑ No ., New Construction: Yes ❑ No F.” A'/VA: Yes ❑r N TYPE.OF INSTALLATION AND SPECIFICATIONS: (No septic tank or`cesspool permitted if public sewer is available within 200 feet.) - Septic Tank: Distance from nearest well--------------__Distance from foundation--------------------Material -----------_---:-------------------.----------_- ❑ No. of compartments--------------------------Size------------------------- ---Liquid depth--------------------------Capacity-----•-------------•--- �t Disposal Field: Distance from nearest well-------�------.-Distance from foundation--------------------Distance to nearest lot line------------------ fv ❑. Number of lines-----------------------------------Length of each line------------------------------Width of trench----------------:------------.----- T Type of filter material------------ ---------Depth of filter material---------------'---xTotai length--- ----_--_----_---_------_---___--_--- ' rJ f # _ �_ Se epa e Pit: Distance to nearest w li:_=:-__L__ ___Distance from fo nd n_. -��__l.D�-sta e to nearest lot dine-_- --- .... �} Number of pits----------�___-_____1 1i�aterial_- -- meter-- "' -- :-----Depth....... Distance from nearest well-----------------Distance from) rdation_--------.- -_:=.fining material------------------------------------- F1 t er-"-------------- --------- ----------De thy- = Li uid Ca aci -_gals. Priv Distance rot - r q p ty----------------------- 9 S y: m�nearest weft--- ------= - -----R_----- ----- - -----------Distance from nearest building---------- -----. ❑ Distance-to nearest lot line______*_.-_-:_~.'� . . - --= Remodeling and/or repairing (describe): ----X? �__ —� --------------•----•r---------- ---------------------------------------------------------------------------•---- ! hereby certify that I have prepared this application and hat the work will be done in accordance with San Joaquin County ordinances, State laws, d ules and regu of the San Joaquin Local Health District. �F : 2 , _------Owner and/or Contractor (Signed) ( ) $Y: = - ... ---------------------------------------(Title)---------------------------------------------------------------- (Plot plan, showing size of lot, location of system in.rela+ion to wells, buildings, efc., can be placsd�'on reverse side. FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY---- --•---------- ------------------------------------------------------------------------------- DATE --------------------------- ' REVIEWED BY------------------------------------- ------ ----- ------------- = - --------------------- DATE �� .. BUILDING PERMIT ISSUED-------------------=----------------------------------- ---------------------------------------------- DATE:_---- Alterations and/or recommendations:------------------------------------------=--------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------- ----------•-----•---•--- -----•----•-•----------•----------------------- ..... N ' - = ----------------------------------------------------------------- ---•-------•------ ------------------------------------------------------ -'---•---------------------------------------- ----------- FINAL INSPECTION BY------- - � --- -= Date--------- ------� ---�-----�--- - ----------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 1114 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E5-9-21x1 , Revised 1.57 EP,CO.