6706 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) I,•.S S Date Issued .q') 4Applical-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, JOB ADDRESS AND LO ATION---------- ________ _______ t ---------------Lyf OwnersName------------- --- ---- ---------- -•---=---------------=----=�----•--•----•------ - -- - �------ i-hone----•----•-- Address = ...:. Lj 1 -'------ - ---------------------------------------------------- �',�'z.�.•¢ � d ---------------------------- ---------Contractors Name------------- ... -- - - �-------------- ------ Phone- --- Installation will serve: Residence ❑. Apartment House ❑ Commercial 0, Trailer Court ❑ +Motel ❑ Other Number of living units: -------- Number of bedrooms __._____ Number of baths --------- LotFsize .__0 ______ __ ______________ / Water Supply: Public system ❑ Community'system Private E] Depth to.Water 7ab1e�` Z?ff:"" i. , Character of soil to a depth of 3 feet: [Sand ❑ ,Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes`E] No New Construction: Yes ❑• No IN-= , TYPE OF INSTALLATION AND. SPECIFICATIONS:' i No septic tank or cesspool permitted if'public'sewer is available'rvithin 206 feet.) ' Septic Ta iSti. a - p from nearest well A_______________Distance from foundation---------------------Material-___________._____________._____________-______-- ❑ o. com Nartments--------- ---------------Size------------- ------Liquid depth Capacity-------- Disposal Field,: :Dis m nearest well-------------------;Distance from foundation--------------------Distance to nearest lot line________________. ❑ umber. ines-''_)--------------------------------Length of each line_- .----------- -------Width of trench----------------------------------- Type os filter materia------------------- of filter material_______________=-----Total length__'__________________:_________________-__ Seepage Pit: Distance to nearest well-.-___� __.----,Distance from foundation_-' ......Dis#anc�to nearest lot line___ �_.__---. --� Number of pits._:_i.._L_______ Lining material __ Size: Diameter_____ _,___..___.Depth......5- -...-_f______________ Cesspool: Distance from nearest,well----------------- Distance from foundation_____._.___,_-y__--.Lining material--------------------------- ________- ❑ Size: Diameter----- ---------------------------Depth------------- -:-------------------------------?---Liquid Capacity----------------------------gals. L ___-____I._Distance from nearest.buildin ..-------------------------- 7 Privy:, DistancE rofm nearest well. ---------------- 5 i ❑ Distance to nearest lot line____------- - - -------------------------------4------------ Remodeling and/or repairing (describe)_______________________ = = I --------------•---•------------------------------------------------------------------ ----------=------------------=--------=--•----------------------+------y....---•-----------•------------ ------------------------------------------------------------•-------------------------------------------------- -------------------------------------- --••---------•-=-------------------------------------------------•-----•-----•-•• -- -------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will-be done in accordance with San Joaquin County ordinances, State Jan and.rules and,regulations of the San Joaquin Local Health District. (Signed) --------- -- ----- ------------- --------- - ------ ------------------------------(Owner and/or Contractor) By: �-� -+ -1----��--9 - -------=-------- •--= -•----(Title)--- S� e (Plot plan, showing size of lot, location of system in relation to wells, buildings,.etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY - f APPLICATION ACCEPTED BY------------------------------------------------- ----------------------------------- --- DATE....... -R ��ta -y S --------------------------- ° REVIEWEDBY-------------------------------=----- -----------------------------------------------------=------------------------- DATE-------------------------------- I BUILDING PERMIT ISSUED--------- ------ DATE---------------------------------------------------------=--- Alter dos and/ r recommen ations: De 0 F = ------- ----=----- ~- -------rj -------------'---- --------- �--- --- ,cam f. Date--=--------- FINAL INSPECTION BY--------- -------"------ ------ J .. - =----------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT l 130 South American Street 300 West Oak Street 132 Sycamore Street 914 North "C" Street I Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised W-2100