6100 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. _. ................... (Complete in Duplicate) Date Issued A plica+ion is hereby made to the San Joaquin Local Health District fo a permit to construct and install the work herein described. This application is made m compliance with County Ord549 inance J�,�_ 4� ------------------ JOB ----3 a 9� JOB ADDRESS AND LOCAT ON___.____.- ----- � Phone_ ----------- ------ Owner's ------ OF wnar sName-------------_ --- Address--------------------'_- ---- -- - --•------------ _ _ _ one 'S�'� ---------•- ------------ ---- Ph Contractor's Name-----:-------------•---•� Commercial Trailer Court ❑ Motel ❑ Other ❑ Installation will serve: Residence �/Apartment House ❑ y ❑ Number of baths . __ Lot size __ - /fid Number of living units: . --- Number of bedrooms _ ., Water Supply: Public system [7�Community system [I Private ❑ Depth #o Water Table Adobe �ardan ❑ + Character of soil to a depth of 3 feet: Sand E] Grave4 C1 Sandy Loam E] Clay Loam El Clay E] Adobe 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.) esti Tank Distance from nearest well_________________Distance from foundation------------------.Material_____._--__._______--.-...._-_____-.--.--------- No. of compartments Size --------------- 'from foundation Liquid depth--------------------------Capacity----------------------- L i�p ,field: Distance from nearest well- Distance"from foundation--------------------Distance to nearest lot line----------------- W of lines------------- --------------------Length of each line-------•---- Width of trench Type of filter material--------------------- -Depth of filter material.......... �--Total length----------------------------- ------Q ____Distance to nearest lot line _ ------ i Seepag it: Distance to nearest well)16 4�'�-Distance from foundation_.___!__,___. _ • .Size: Diameter._.__ _6 ��_-----Dept h--- `r----------- . Number of pits----�-------------Lining matenal_Si_. Cesspool: Distance from nearest well-----------------Distance from foundation-._ --....___.-._.Lining material--------------_..__---------------.-. (V. Depth.......................... --- --------- ---------......................... ------- -------- -----Liquid Capacity -------------------------gals. ! 171Size: Diameter--- - -�----- -�------ ----------- i Distance from nearest well___..-.-___�---_---- Privy: Distance from nearest building-- .---------------------------- Distance to nearest lot fine---------------------------------------- ---- ----- --••------------------- ------------------------------------------------------ El Remodeling and/or repairing (describe)---------- ------------------ ----- -------- - ----- ------ ---------- --- --- ----•- -------------------------------- ------------------------------------- -------- •---------------- ------- - -- -------- ------------ ---------- --------- -------- t - - - --- - - I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, S to laws, rules and regulations of the San Joaquin Local Health District. • O er and/or Contractor) :._ (Signed)---- _. _/ - - --- ` (Title SY� ---- ---- (Pliot plan, showing size of lot, location of system!inr tion to wells, buildings, etc., can be laced on reverse side). FOR DEPARTMENT USE ONLY DATE--------- -- APPLICATION ACCEPTED BY -------------- 77 ---- _•-, DATE - - ---- ----- REVIEWE - ----- REVIEWEDBY-------------------------------- DATE � �- ----------------•---• BUILDING PERMIT ISSUED.-------- _ ------ . ------ Alterations and/or recommendations:._.._-_.__.. ---- --•------------------------ -------------------------------------------------------- ----------------------------- ----------------------- Date.... - --.s~ ---------------- FINAL INSPECTION BY:------- ......�--- ---�--=--=�------ - SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C" Street 130 South American Street Trac California Stockton, California Lodi, California Manteca, California y� k ES-9-2M 145446 ATW Ud t2-54