11007 - Laserfiche WebLink

Home Browse Search

I APPLICATION FOR SANITATION PERMIT Permit No. t' (Complete in Duplicate) Date Issued ----- _____ r9 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 LQCATION-------!2C_Q_�12-- _- ---- ------ --- Phone_ Address.- -- - -------- -- Contractor's Name_____.__�_ � Phone-------------- Installation will serve: Residence Apartment House-E Commercial E]- Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __f_. Number of bedrooms___ Number of baths _/---- Lot size -•_______ ---------------- Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table 465—ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Aclobjekf Hardpan ❑ Previous Application Made: Yes ❑ N0 New Construction: Yes,g No ❑ FHA/VA: Yes,❑ No-N,- TYPE om TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or`cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well----------------`Distance from foundation--------------------Material-------------------------_-_-___----._--__----. No. of compartments-------------------------- Size-_..--------------------------Liquid depth----------------- -------Capacity---------------------- isposal 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 ____.__________________Seepage Pit: Distance to nearest well_. tf Distance from f ndation_ _______ r.Distance to nearest lot linen-�.c Number of iaits-- -- -- ---- -----Lining rna#aria) - ----.Size: Dia eter--, -��--------.Depth_._--------------- Cesspool: Distance from nearest well-_-_-_--__--____Distance"from foundation-------------------Lining-material__------ --------_--------__------. [] Size: Diameter------------------------- ------Depth----------------------------------------------------Liquid Capacity----------------------------gals. rivy:' Distance from nearest well _____________-----------------------------------Distance from nearest building----------------------------- ____---__. ❑ Distance to nearest lot line---------------------------------------------- -------------------------------------------------------------------------------------------- Remod dor re airin describe :__ _. n _-_- - - -�_4 l -___ p/ p 9 ( ) = l-- --- ----- ---- --- -------------------------------------------------------------------------------------- ------ ------------------------------- ---- a , I hereby certify that I have prepared this agplicetion and that the work will be done in accordance with San Joaquin County ordinances, State,laws ndlrule an a ulationof th an Jo in Local Health District. r (Signed) - ------ ---- rt----- -------- (Owner d/or Contractor) By:-------------- - --------------------------------------------- -----(Title. -- -- ------------------ (Plot plan, showing siz of lot, Iota ion of system in .relation to wells, buildings, etc., can be placed on revers fide}. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------------------- ------- -------------------------------------------------- DATE---- C------ A REVIEWED BY----------------'------------------- s.i ' ' DATE---------- --_) ------------------------------------ ------------ --------------------------------- BUILDING PERMIT ISSUED ----- -- -: " ,- DATE ------•-- �-�`` Alterations or recommendations:-_-__.__-_______�.. ' -------- _______ ______'_--------_____._ ----------------------------------------------------------------------- --`i� ------------- ------------------ -------------------------- 7---------- --- ---- ---- -- ------------------------------------------- ------------------------------- -- - -- ---- -- ---------------------------------------------- :' FINAL INSPECTION .BY:--__ _.__ - -------I ------ ------- ---- Date--- -------------- ----------------------------------------------- e�rAI4�$KQUIN LOCld+L HEALTH DISTRICT 130 South ericen et �0 West Oak Street ;;kef eamore Street 814 North "C" Street Stockton, Cafiforme Lo i, California etg, California Tracy, California ES-9-21x1 Revised 1.57 F,P.CO. �a, G� l