5421 - Laserfiche WebLink

Home Browse Search

.!______---•------- --•- APPLICATION FOR SANITATION PERMIT Permit Nd � (Complete in Duplicate) Date lssued7 �.----0 APp Lica+ion hereby is made to the San'Joaquin Local Health District for a permit to constrr;uct and install the work herein described. This application is made in compliance with County Ordinance No. 549- �' ---- rg e'er--+'--------------------------------------------------- --- --- --- -- JOB ADDRESS AND LOCATION_-_"_ l�_ -- --- ---- � - -�f Owners s Name j- �C�'-le --------------------------------------- -------- Phone Address------------------------ ---------- 1.//� . '' ' ------- C.hJ .�,a�- ------- -----`----- Contrac+or's Name--- ___-� � Installation will serve: Resiclence)j�[, Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ----I_ Number of bedrooms _�Number of baths ---L Lot size -----" ------ + - Water Supply: "Public system)=Community system ❑ Private ❑ Depth to Water.Table *t.f- Sandy Charaof soil to a depth of 3 fee+: Sand ❑ Gravel ❑ Loam ❑ Cla Loam ❑ Clay ❑ Aclobe�Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: No septic tank or cesspool permitted if public sewer is available within 200 feet.) e1CTan Distance from nearest well -_-__"._-Distance from foundation--------------------Material--------------------------------------------------- No. of compartments-------------- ---------Size--------------•-----------------Liquid depth--------------------------Capacity----------------------- Dis Field: ;- Distance from nearest well-----------------Distance from foundation---------------------Distance to nearest lot line--------_......... �_ o E'^^" Number of lines------ ------------Length of each line----------- ----------Width of trench----------------------------------- Depth of filter material----------- -------Total length------••-------_----.--------------------- Type of filter material-:"-_-.----__. p Jr --- Seep e Pit: ` Distance to Weare well j CL Distanc f f ndation_1�_�_-__-_.Distance to nearest lot line--_j�J---` Number of pits.--i ---- -----Lining material Size: Qianieter" -offDepth_ --- -------- - - Cesspool: Distance from nearest well-----------------Distance from foundation..-- ----------- Lining material_- gals. ❑ -Liquid Capacity---------------------------- .I Size: DiameterDepth----- -- ------------ ----------- ---------- --- g7 r Privy: Distance from nearest well.."---------------------------------- -----------Distance from nearest building------------------------------------------- Privy: ---------- -------------------;---------. ❑ •--- ------------------------------------------------------------- ---------- Distance to nearest lot line----_-----------------=----------------------------------------- - --------------- - -----•---------------•-----------------------'----•- Remodeling and/or repairing (describe:--____..___----__"_-- - -------•-------------"--`-----•- "" - ----------------•"-----•-•-------�-------------------------------•- -- -•--- ---- ---- ----- -- 1 hereby certify Aha+ I have prepared +his application and that the work.will be done in accordance with San Joaquin County ordinances, S{ rules and re lations of the San Joaquin Local Health District. r - - -}---- - Contractor) (Signed)_ - ------- - --------- -- ---- ----------------- - - - -------------------------------- " By:------_------------ ----------------------------------------------- ---- - (Ti+le) / -N 10 ------------ -- ----- -- (Plot plan, showing size of lot, location of system in relati n to wells, buildi s, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY CT PTEA B APPLICATION AC __ ---------------------------------- DATE "1-�---------------------------------------------------- REVIEWED BY------------- ----------- ----- -- - ----------- - ---------- ------------.-------•---------------------------------- DATE 2 DATE BUILDING PERMIT ISSUED---------------------------- -------------------------=---------•- Alterations and/or recommendations:-----:------.----- --•------•----------------------------•---•-•-•-----"------ - --- ------------ -- -------------------------------- !J'!1� Date------ ---------�-----. -------------------------------- FINAL INSPECTION BY:_"_------------------- - -- -- -- - - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak-Street 132 Sycamore Street 814 North "C" Street: Stockton, California Lodi, C61ifornia Manteca, California Tracy, California E5-9-2M Revised W-2100