5789 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT ` Permit No. (Complete in Duplicate) .* p --�- _ � Date Issued .l -_ Applica�ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the w rk herein described. This application is made in compliance with County Ordin o No. 549. E I JOB ADDRESS AA OCATION _ --------- ------- --------• , Owner's Name.-- - f JCl� ---- Phone-'r?le -�— Address .-ti.-- ------- --- -------------------------•--------------------------------------------=----------------------------/--- ------------•----- Contractor's Name------------------ --------- ----------------- ---------------------•-•------------------- Installation Phone - a to y 0 will serve: Residence 0j Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ dd Number of living units: __J�__-_ Number of bedrooms _Y_ Number of baths ---f, Lot size _____�_-____r__�.._��P_ ------------ Water Supply: Public system ommunity system ❑ Private 'Depth to Water Table ft. , ! Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam ❑ Clay Loam ❑ Clay ED Adobe a-"Hardpan ❑ Previous Application Made: Yes ❑. No ErIN-ew Construction: Yes ❑ No ❑ a.� -a- C , .� TYPE OF INSTALLATION AND SPECIFICATIONS: v (No septic tank or cesspool permitted if public sewer is available within 200 feet.) pticank: Distance from nearest well-----------------Distance from foundation_--_-_-_-____-__._.Material__-______-_.__-______________________-_..___-... No. of compartments--------------------- ---Size-----------------------------------------------------------Liquid depth--------------------------Capacity--------------------- D asal 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-------------.---------------------------- [ Seepage it: Distance to nearest well ___ .,) Distance frofoundation__040_ ____...Distance to nearest lot line___------ Number of pits-__ 1------_ lig material. ±& 1C�5_--_.Size: Diameter___, _ 'r _.___.Depth-__Z115----_________________ Cesspool: Distance from nearest well-----------------Distance from foundation-------------------.Lining material-__.--_-.-_.--_-__-_-_-__----_-______- ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity...........-----------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ ElDistance to nearest lot line--------------------------------------------------•-"----------------------------------------------•------------------------------------- Remodelingand/or repairing (describe):--------------------------------------------------------------------- -------------------------------•-••----------------------------------------- --•-----------------------------------------------•-••----------------------------.._-_---.----------------- ------------ -------------------------------------------------------------------------•-------------------------------------------------------- -----------------------------------------------•--------------------•----------- ------------------------------'•-----•-------------•"----------------------------•---------••-----------------------•--------- --------------------------------.....---------------------------------------------- I here6 .fify that I have prep red this application and that the work will be done in accordance with San Joaquin County ordinances,�Stat laws, and rules an egulations of the San Joaquin Local Health District. (Signed)------ `---- ------------•------- � Cantracto .el *r By:----------------------------------------------------------------------- al 4-----------{Title) 471 C _)"�-------- [Plot plan, showing size of lot, location of system in relati n to wells, building, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY ------------------------------------------ -------------------------------------- DATE---------------------------------------------------- REVIEWEDBY-------- ------------------------ ....... --- -------- ---------- ------------ - •--------------------------- DATE-- -------------------- ..---• --------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------YS-_-.-,------------------------•--------------------- Alterationsand/or recommendations:---------------------------------------------------------------------------------- -------------------•-----...------------------------------------------------ FINAL INSPECTION BY..------�__ � Date--- / �- 5 -------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American S+reef 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 •�