4127 - Laserfiche WebLink

Home Browse Search

_ S V APPLICATION FOR SANITATION PERMIT Permit No. . � (Complete in Duplicate) Date Issued Ap llcation is hereby made to the San Joaquin Local Health District for a permit to construct and install the work erein described. Thiss_application is made.in.com`3liance with County Ordinance No. 549. Na 1-6 �'--- JOB ADDRESS AND LOC TION__ ______----1-----*--fZ�-Z' Phone------------------------------------ Owner's Owner s Name____- _ q� 1 -------•--- -- a one--- •------------ ------ Address Contractor's Name__________ ____ .. Trailer Court ❑ Motel ❑ Other r Installation will serve: Residence �Apartmenf House ❑ Commercial ❑ / r rr 4— Number of baths —/--- Lot size f sT fly Number of living units: _-l.___ Number of bedrooms -- Private0----Depth to Wafer Table ._Y� ft. Water Supply: Public system ❑ Community system ❑ Clay Loam C] Clay ❑ Adobe {►•Hardpan ❑ Character of soil to a depth of 3 fest: Sand Gravel ❑ Sandy t ❑ . Y Previous Application Made: Yes E1No 93 NewConstruction: Yes ET";No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: . (No septic tank or cesspool permitted if public ewer is available within 200 festa // I - Materia4_--1--------- i Septic,,Tank: Distance from nearest well_--10_�-_---Distance from fpundation____ham----- --. „ Q ----------- No. - - ----� 1 ' � "Z ----- ----Size...-- ----�.��._��r-3_Liqu�d dept/-----�o�_ ------- CapacifY--- -- - - � No. of compartments___--..____- __ yn Distance to nearest lot line----- -- ------- Disposa Field: Distance from nearest we L__ _ --- -Distance from foundafion----- --- - ----Widfh of trench.___- ------------ p Number of lines______________� __._ -- -----Length of each line,________.. l� �� g a __ _De th of Pilfer material_-----//---�-�-----Tofal length-----.c..�-4---�-------- -----------�- I Type of filter material/y . -- Dep ___---._.Distan�e to nearest lot 1• e�_-- � ---Das#ante fr frr�ou ation_-.-___ ps Pit: Distance to nearest well___-� _�.--- @ � - ��-----------.Deptn--a-- -------•-------------- See Number of pits.__.__/-___._-___--Lining material_________ Size: Diameter--___ IN Cesspool: Distance from nearest well-----------------Distance from foundation------------------Lining material --- --- ---------------------gals t ❑ Size: Diameter------� --- Depth------------------------------------------ - ---- q ---• -------- ------------• Distance from nearest building---------------------------------------- Privy: Distance from nearest well------------------------ ---------------------------------------- Distance to nearest lot line_____.____'_______----- ---------- Remodeling and/or repairing (describe):---------------- ------------------ - ----•-------------------- ---.------------ > > ------ -------- -------------------------------- I hereby certif that l have prepared this application and that the work will be done in accordance with San Joaquin County t.. I� ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. ------------------------ O wner _ -._-_-__-__•-. --_-_-_._Owner and/or Contractor) Signed --------------- --- -- - (Plot pian, 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---------- ---I----------- 3C -- --------------- ------------------------------------------ ----------- DATE -----------------�- -------- _/......--------------- REVIEWED BY----------------------------- ------------------ BUILDINGPERMIT ISSUED----------------------------------------------------- ---------------•-•------•------------ ---•-------•------- Alterations and/or recommendations:--------------------- - ---------------------------- ------------------------- -------------------------------- ----------- --------------------------- -------- -- ------------------------ --------------------------- .' Date----------- ------ - R ....------------------------ FINAL INSPECTION BY.._______-__y...-.-- �•- -- �� SAN JOAQUIN LOCAL HEALTH DISTRICT 132 Sycamore Street 814 North "C" Street 130 South American. Street 300 West Oak Street Tracy, California Stockton, California Lodi, California Manteca, California cc—o�9�A io-52 Revised W-2100 `F