2906 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. ------ _- {Complete in Duplicate} � 1-_91 Date Issued ------�`__- s_�- 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 rdinancalNo 49. JOB ADDRESS A OCATIO __ ._�f -�.- -- . ------- ` - ------------- -------- Owner s Name . -------- -- ' Phone-------------------------=---------- - - -- - 4 _. Address----�`� !- t --------------------- ----------- - -- ----- Contractor's Name-- ---- ------------------ Phone---------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motpl ❑ O``tggh9r ❑ Number of living units: _ 4___ Number of bedrooms __%3_ Number of baths ___!'__ Lot size __ �--X - 1�-------------------------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand Gravel E] Sandy Loam Clay Loam F1 Clay E] Adobe�ardpan ❑ Previous Application Made: Yes ❑ No 7New Construction: Yes K No ❑ " TYPE OF INSTALLATION AND SPECIFICATIONS: ' {No septic tank or cesspool permitted 1f4u6l1c sewer is available within 200 feet) lr I Septic ank: Distance from nearest well Dista c &m fq�nbnhgn------ _________ _ ____ ___ --- C __ No. of compartments----_.__-- _ Size �.��-�-- ... Liquid depth----------t*C'----------Capacity--- -- _I Dispos Field: Distance from nearest well ___--Distance from foundati}�}[__ _____-___ Distance to nearest lot •nej-__ ___________ t Number of lines---------- - ---- ------------ ength of each line-_-_-!(J..--"- -_ Width of trench------_J- Lf-�--t t -Total length 1.. Type of filter material __'( +~pth of filter material____-__�- g i Seepage Pit: Distance to nearest well----------------------Distance from foundation_-.._______.r__....Distance to nearest loft lin e________________ ❑ Number of pits----------------------Lining material----------------------.Size: Diameter------------------------Depth--------------------------------- : = 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__________________________--____________. ❑ Distance to nearest lot line--------------------------- ---------------------•---------•-•-------------------------------------------------------------------------------- Rem g dror &pairi (descri e ' -----------------------•------------------ ------ �_ �� �- = --- -------------`---------------------------------------------------------- z -- -----------------------•---------------------------------------------------------•--------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County I ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. [Signed #' �' ---- -----------------------------------------------(Owner and/or Contractor) }-------> ------- '- Title---------------------------------------------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can 6e placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY___ . ------ DATEt� REVIEWED BY------------ --------------- -----V---- --- ---- ---- --- ----------------------------------------------------------------------------- DATE -------------------------------------------- ---- BUILDINGPERMIT ISSUED----- -------------------------------------------------------- DATE -------------- ------------------------------- Alterations and/or recommend ----------- -' ===- T _----- "' - dw)------------ -- Ut Av - t*kA�'------ ------ -------- v ' -------------------------------------------------------------------------- -------- -- k- - � � ------------ --------------------- --V-9-;- - - --------------- - � --------- FINALINSPECTION BY:------ ------------------------------------------------ Date--------- -- ------ ----------------- ------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street , 132 Sycamore Street 814 North "C" Street - k Stockfon, California Lodi, California Manteca, California Tracy, California i� ES-9-2M 8-51 Revised W-2100