8486 - Laserfiche WebLink

Home Browse Search

S� APPLICATION FOR SANITATION PERMIT Permit No. _- --*��1-- ----• +X�/�,.7� (Complete in Duplicate) 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 Ordinance No. 549. ------ -- "'s/`� -------------------------------------- JOB ADDRESS AND LOCATION__:__ _ 1-- - Owner's Name------------ Address ---------- t�- - -=------- ----------- Phone Address------• ----- ----•- ----------- s Phone ,.__ � , Contractor's Name---------------- - -- ------ - H Installation will serve: Residence partment ouse❑ Commercial ❑ Trailer Court E] Motel ❑ Other Lot size ' ----------'----------- Number of living units: ___/___ Number of bedrooms/___.. Number ofKb __/---- - '-- Water Supply: Public system Immunity system ❑ Private ❑_Depth to Water,Table _______- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam El Clay Loam El Clay C] Adobe dpan ❑ Previous Application Made: Yes New Construction: Yes "o❑ TYPE OF INSTALLATION AND SPECIFICATIONS:' 1 l (No septic tank or cesspool permitted if public sewer is available within 200 feet.) _ n.�, .,, . S tic Tank: Distance from nearest well_________________Distance from foundation_____--______.__--.Material___________-._..______._______.___.__,_________. No. of compartments------------------------------ -------- ------Size---------------•--------•------ Liquid depth---------------- Capacity -------- y well.___-________..Distance from foundation--------------------Distance to nearest lot line Qis osal Fi N'umber of lines earest = Length of each line--------- .Width of french----------------------------------- ---De'th of filter material----------------- -----Total length-_-------------------------------------- Type of filter material-___________._-._____ p r ..', Distance to nearest lot lin=�___-_______ Distance from fou dation____. --- Seepage Pit: Distance to nearest well-. /�'Z$ -- *�- Number of pits.__.___-f_______---_Lining material- --.-----r-- i?e= Diameter_- p +�� Cesol: Distance from nearest well_________________Distance from foundation.__._.----..___.---.Lining material__.._.----______-------------- ----- Cesspool: ----Liquid Capacity----------------------------9 ❑ Size: Diameter-------------------------- -------- P Privy:' Distance From nearest well----------------------- ----- --_-______._Distance from nearest building------- �- . _ ❑ Distance to nearest lot line__.--.------"'------------------ ------- ____________ ___________________________________________ ----------•--------------•----- --;------ Remodeling and/or repairing (describe):--------- ----------- ------------------ - -- ----•---- ------------------------------------------------------------------------------------------------------------------- ------------------------------------------- --------------------------------------------------------i I here6-ter fy that at I havrules pr dared this application the Sant Joaquin hL ca{ Health�eDi}rI {n accordance with San Joaquin County ordinances, State er and/or Contractor) 5i ned [ ) -----4 ;tle} P__ -- ---- (Plot plan.-showing size of lot, to tion of syste n relation to wells,�6�uildings, etc., can 6e placed on reverse side]. FOR DEPARTMENT USE ONLY t DATE------ I --------------------------------- APPLICATION ACCEPTED BY____._._--x____---- ------- ---- - -------------------- ••----------•------------------ �-� DATE----- - --- -- ."-------------------------•-------- REVIEWED BY : - ------------= DATE--'- -�..... `i --- ----------------------------- BUlLD1NG PERMIT ISSUED------------------'------ - t - -o-- Alterations and/or recommendations:--!--------- - ---------- ---- ---- ------------------------------- ----------- - . : -------- - - :::::_::::::::: - _ ____________ IJ- ' Date---__ --- - ---------- 1�' - R FINAL INSPECTION BY---- -----------�----- -- - I SAN JOAQUIN LOCAL HEALTH DISTRICT 132 S camore Street 814 North "C" Street � 130 South American Street 300 Wast Oak Street y Stockton, California Lodi, California Manteca, California Tracy. California ES-4-2M Revised W-2100 –