5154 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No_ ________ (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. , JOB ADDRESS AND LOCATIO -----_1T -- - --------- ---- - -- --------------------------- ------------------------------------------- -- Phon " OwnersName------��------- -+---D'-•--=-- ---------- -------------•----- ------------- -----------------�,-_------------- ----------- ry� 17t.- Address .---------- ----- ---- ---- -- Contractor's Name -�-- -------`- ------, - ------ - ---------------------------------------------------- Phone Q Installation will serve: iResidence [B�Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ i Number,of living units: .�. � ------------------------- Number of bedrooms __ - Number of baths __ Lot size ____ Water Supply: Public system ❑-Community system ❑ Private ❑ Depth to Water Table _V6 ft.. + Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe(Hardpan ❑ i Previous Application Mader Yes ❑ No New Construction: Yes E] No xf ' P s TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank'or cesspool permitted if public seweris avai a le wW4hin.200 feet.) i Septic Tank: Distance from nearest well_________________Distance from foundation--------------------Material_-_-----___--__-__________-__--_.___-._________- ` ❑ No. of compartments - Size ----------------- Liquid depth Capacity Disposal Field: Distance-from nearest well- ------------Distance from foundation______________--_.Distance to nearest lot line______ ------ Number of lines-------=--------------------------Length of each line------------------------------Width of trench-------.--------------------------- �- Type of filter material___________________ ___Depth of filter material----------------------Total length------------------------------------------ � r line- See it: Distarice'to nearest wel!_-_..._��_- Distance fro fou ation----- ___...___.Distance to nearest lot line----____- ( D of pits___.___-l-__________Lining material�r�,L ________ Size: Diameter X3'3 ------- NumberQeptnS Cesspool; Distance from nearest well------------------Distance from foundation__________---' Lining material__..,-__'__._- % ------------------- ----- '_____f__-______- .:-. ...,.-. `- w .�li D..epth - r ... ----------------------- gals.Diamee .-- -- uid Ca acitY❑ Privy: Distance-from rearestbuilding �t well---------------- --------------------.------------Distance from nearest building--_--------------------------------------. Di€stance'to nearest lot lire:.:----------------------- ------------ - .:.-_. ------ Remodelingand/or repairing (describe):--------------------- -----------------------------I---------------------------------------------I------------------------------------------------------ -----------------------•---------------------- ------------------------------------------- ----------------- --------------- ---------- ---------------------------------------- ---------------------------=------------------------------------ -----••--------------------------•--•-------•---------------------• ------------------------------------------------ P I hereby certify that I have prepared this application-and,f hat the work will be done in accordance with San Joaquin County ordinances, State law and rules and regulations of the San Joaquin Local Health District. 5 ned ---- ------- ---------------°---- ---- _ ,. - = --- - ---- and/or Contractor) ( g )---------- - , F BY: - ------- -------- ----------------•----=-------------------------. (Title)- - ---------- ------ -- ----------------- (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 r ----------'--- ------ DATE- j/ ----- APPLICATION`ACCEPTED ______ _ __ ` REVIEWED BY------------------=---------------------=------------- ------- ----------------- -: --- ----- --------- --- -= --- ----- --Y------------------- DATE---- --------- ---•----------------•------------------ BUILDINGPERMIT ISSUED------------------------ --------------•--------------------- -------------- -• DATE-•----------------------------------------------------------- Alterationsand/or recommendations:--------•------------------------------------------.-------------------------------------------------------------------------------------_----- ----------- ---------- ------ t -----•------------------------------ --------••-------•---------------------------------------------------------------- ---------------------------•-------------•---------------•------- ; ------------------------ ---------------------=-----=--=--=----- -------------------------------------- ----•-_--•-----------•-------------------------------------------------------------------------------------- t FINAL INSPECTION BY___________________ Date------- LJ..: CS'= ---------- --------------------------- e 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 ES-4-2M . Revised W-2100