6180 - Laserfiche WebLink

Home Browse Search

1� APPLICATION FOR SANITATION PERMIT Permit -----..G (Complete in Duplicate{ Date issued � pplica{ion is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein described. This application is made in compliance withCounty Ordi ante No. 544. JOB ADDRESS AND CATION__ _ -------- -- - ,J-•` --- - -- Owner's Name ��_.� - -- PhoneT_J._�---�----- Address------------- =i:1. ----•--------------------•-------------------------------------- Contractor's Name---- •------- ------- ------------------------------------ -----------------------------•------------ ----- Phone----------------------•----------- Installa+ion will serve--Residence Apartment House El .-Commercial-E] Trailer Court ❑ Motel ❑ O her ❑ -A- Number of,livirig units: ____I__ umber of bedrooms _�-- Number of baths ._I---- Lot size . - - ----------------------•--••--�--- Water Supply: Public system Community system [IPrivate ❑ Depth to Water Table __.----- ft. Character of soil to a depth of 3 feet::Sand,❑ Gravel Sandy LoClay Loam ❑ Clay.❑ Adobe Hardpan [3Previous Application Made: Yes ❑ No ,[g New Construction: Yes ;--'No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic'tank or cesspool ermined if ublic sewer is available within.200 feet p P 1 eeY 5e tic nk: Distance from nearest well_,_ _Dista c fro �floun tion!_ _____:_____...Ma`teipi__.. _______ .___.w6________ P gX J� _!_-Liquid eptly 7=- ---.Capacity-- No. of compartments------- ue_ __.•___- - -- ' Disposal ield: t Distance from nearest ell._. istance from foundat' n__14-� stance to nearest lot lin . � � � °�' ------ _/� Number or lines.__.___._ - __. ,._Length of each IinEy ."- lT/-'iVtlidth of trench___.__ Z- 1�S �f y -- t Type. of filter mater L -- ____---'Depth of filter material___.___I_ -___ ---Total length_____...-- - - ---------_-.-..---- Seepage Pit: Distance to nearest well-.--------------------Distance from foundation---------------____.Distance to nearest lot line--_-________._-_- ❑ Number of pits----------------------Lining material.--------.--------- -.Size: Diameter-----------------------Depth----------------------------:--- Distance from nearest wel ----------------- ffoundation__-._-__-- ---------Lining.material__._____.._._________.___--_---_____. Cesspool: G, ❑ i Size: Diameter------------------ '---------------Depth----- --------------•I------- - -------------------Liquid Capacity- --------------------------gals. QV Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-------------.-_--.___________.__________- ❑ Distance to newest lot line- ----- ' I :�.----.•-.�-?t----- Remodeling ancf or r airing (describe :_____-_-_. t� � l.. -------•- - ,� ------------- r ---- ------ ------ ----- ---••--- ------------•-•-•--------•------------------------------------•-------•---------•--•-----------------------------------------•------------ ----------------- - = -------•--------------------------------------------••----------•----------------------- --------------------------------------------- --- --- - - 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 a re lations of the San Joaquin Local Health District. �f ---------------•----------------•------------------- - {O,wner and/or Contractor{ Sy=-------------..... -- ------- ----------------------------------------------------•----- {T�+ le] ------------------- - - - (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 APPLICATION ACCEPTED BY ---------------------------------- DATE- Y REVIEWED BY------------=----------------- _ DATE --------------•-------_---------------------- BUILDING PERMIT ISSUED----------- DATE--------- ---------------------------------------------- Af Alte do nd/or rowrecomme ndation S-------------- ------ - ------ -------- - ----------------------------------------------- - . -------- -------- ........ - ----------------------------- --------------------------------------- ------J--------------------- -- , r FINAL INSPECTION BY:._- ------------------- Date_ -------- S- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 3o0 West Oak Street 132 Sycamore Street - 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E$-J-2M 14"4 6 ATWDOo ,2-Sn