2554 - Laserfiche WebLink

Home Browse Search

x ---APPLICATION FOR SANITATION PERMIT Permit No. -- � (Complete in Duplicate) Date Issued Application 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 L CATION--- Sri�� = -5, ©--------------------------------------------------------------------------------------------------- --- Owner's Name G� wr Phone--------------- ---•--------------- --------------------------- ------------ - --- ---- -' - :i.G s+sK v� -.�. ------ ---------------------------------------------------------------------------------- Address Contractor's Name..... ------r- -----,"=---- ""Z/---------------------------------------------------------------- -------------- Phone-_a_'-7_90_-' Installation will serve: Residence In Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __J___ Number of bedrooms _ _ Number of baths _/_,_ Lot size ________________________________________________________-_ Water Supply: Public system N Community system ❑, Private ❑ Depth to Water Table -----z__ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No K New Construction: Yes ❑ No A F TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r Septic Tank: Distance from nearest we€I_________________Distance from foundation--------------------Material-----------_-___--_________________________:___. No. of compartments----- ---------------------Size--------------------------------Liuid depth-------- ..___Capacity Disposal Field." Distance from nearest well_,?LO��...Distance from foundation____-:kf-------- Distance to nearest lot line-----sS-------- Number of lines-----------f--- ---------:----Length of each line-----:5_--__----------------Width of trench------- ----------------- Type of filter material__-14, Depth of filter material_____/4--�.---__-.Total length_____S__ift'_________•__-___-_-_-_ Seepage Pit: Distance to nearest well-_____________________Distance-from foundation-------------------.Distance to nearest lot line----------------- ❑ _Number of pits--- ------------------Lining material-----------------------Size: Diameter------------------------Depth------------------- Cess ool: Distance from nearest well-----------------Distance from foundation------.-------------Lining material---------------------- ❑ Size: Diameter---------------------------------------Depth--------- ------------------------------------------Liquid Capacity----------------------------gals. Privy: w- •- =Distance from•nearest well--- ____,_:_--:__T _-Distaaca#rom nearesf buiading_-Y_-_._�___�_.._,.i. ❑ Distance to nearest lot line--------------------------------------------------------------------------------------------------------------------------------------------- Remodeling ---------------------- ----------------- Remodeling and/or repairing (describe):-------------- .r . ...... ----------------------------------------------------------------------------------- -------------------------------------------------------------------•-•---------- --------------------------------------- ------•---•-----••---=----------------•-----------•----._...._.._...--------------------•--- ------•---------------------- -------------------------------------------------------------•-•-------------------------------------------------------------.--------------------------------------------------------------•---------------------------- 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 ryt9s and regulations of the San Joaquin Local Health District. (Signed)-- ................ i ned)- ___(Owner and/or Contractor 1 70�-- Y:--------------------------------------------------------------------------- ----------------------------- ------(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 APPLICATION ACCEPTED BY -------------------------- DATE --- REVIEWED BY--------------------------------- - --------------------------- DAT -- � 4 -------�' BUILDINGPERMIT ISSUED------------ --------------• -------------------------------------------------------• DATE------------------------------------------------------------- Al+eraflons and/or recommendations:--•-------------------------------------------------------------------------------------------------------------------•--------------------•------------------- 1 -----------------------------------------------------------------=--------------------- ---- -- ---- ---- --- - ------ ------------------------•------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------•------------------------------------------ -------------------------------------------------------------------------------------------------------------•----------•------------•----------• = -•---------------------------------------------------------------------------------------------------------•---- -----------=------- ---------------------------------------------------------------------------- I FINALINSPECTION BY------------- - --------------------------------------------- Date-=------------------------------------------------------ ------------------ 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-9-2M 8-51 Revised W-2100