7580 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued -- ----- - Ap lica4-io'h is hereby made to the San Joaquin Local Health District for a permit to construct and ' t 11 the work h - described. i r ina" _psja e v_rk her This application is made in_comp[ wit County 0 d' �o. 4 9. P JOB ADDRESS AND LOCATION.--_ _... 10 45- - ------------- ---------- --- ------------- ---------- --- Owner's Name--------------------- - ------ ---------- ------------- ---- Phone-------—---- ---- ----------- Address-------__------------- ----------- ---- Contractor's Name - -----------1•--- ---------------- -------- ---------------------------- ---------------- Phone Install.ation I will serve: ResiclencerV Apartment House E] Commercial ❑ Trailer Court C1 Motel 10 Other E] Number of living units: -------- Number of bedrooms Number of baths ---I-- Lot size --------- •1---7 -------------------- Water Supply: Public system 01 Community system E] Private.[]" Depth to Water Table ff. Character of soil to a depth of 3 feet: Sand F] Gravel ❑ Sandy Loan- "Clay Loam Ej Clay [-] Adobe AEr Hardpan ❑ Previous Application Made: Yes Ell: No New Construction: Yes` [ No rl TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool peirmiffe'd if public sewer is available within 200 feet.) Septic Tank- Distance from nearest well--—---Disfancefrom foundation--- �-D-------- 7/ Mate 'al------------------ -- ----- ---- -------------- ----- -- No. of compar4e.rits--------2.,-----,/..........Size_ -Liquid depth___________________ .____Capacity-.___ - Di;pos P Field: Distance from nearest well_.:��_Distance from fcundatidn----- Distance to nearest lot line---..-- ---------- Number of lines-`--------- -------Length.of-each line----------G!� ---Width of trench..-_------7 4-`t 4-tl).pth of filter material-------/Y---------Total length--------•----- Type if filter mi;teri,�_'_;. I Itt--- - Seepage Pit: Distance to nearest well._-------------------Distance from foundation-------------------bistance to nearest lot line----------------- El Number of pits........ .............Linin-g material--------•--------------Size: Diameter------------------ -----Depth--------- ----------------------- Cesspool: Distance from nearest well-----------------Distance from foundation....-._------ Lining material--.--_--...__-:. a ----- ----------------- El Size. Diameter.----_----------------------- -------Depth-F---------------------------------- ----------_Liquid Capacity--------------------------.-galss. Privy: Distance from nearest well---------------------------------------------I----Distance from nearest building-----__---.--________---_ I El Distance to nearest lot line--. ---------------------------------------------------------------------------------------------:------------- Remodeling and/or 'repairing (describe):--------- ------------------- -------------------------------------------------------------------------- ------------------------------------- ---------------------------------- ----------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------- ----------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------- -- ------------------------------------ -• -----•---------------- -------------------------------------------------------------------------------------------------------------------"I------------------------------I---------- 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 and regulations of the San Joaquin Local Health District. (Signed)_A ------- -------------------------------- f ---------------((?wner and/—or Contractor) By:----:------------ ----- ..•---•`----•-•---------------------" ------------------------------------------------------_(Tifle)------------------------- ----------------- -- ----------------- (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----- -----I. ...... REVIEWED BY----------------------- -----------------------------— ----------- -------- DATE---------- lof j --------------- --- ----------------------- ------ -------------------------------------------------------- DATE-------- -------------------------------------- BUILDING PERMIT ISSUED I— ------ ------------- DATE Alterations and/or recommendaf ions:--------------------------------------- --- ---- I - -------------------------------------------- ------------------- ---------------------- I------------- ------------------------------11--------------------- ----------------------------------------------- ---------------------------------I--------------------------------------------------------- --------------------------- ----------------------------------------------- - --------------------------- ------------ -----------------------:---------------------------------------------- ---------------------------------- -------- -- ----------------- ---------------------------------------------------------------------------- ------ ---------------------- ----------- ----------------------------------------------------------------------- ---------------------------- -------------- ------------- ------ ---------------------- ------------- -------------------------- ----------------------------------------------------------------------------------- .......... FINAL INSPECTION ...1Date--- 2 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 s446 ATw...