5831 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued --_:_,(L hv.. Applica-�ion 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. r � /0 JOB ADDRESS AND LOCATION... 3_`-U/YG?a----------1Q--'�...-- Owner's Name --------�F%►'+•h=----------R_, _...-----1.-*'- t-J4_l� Phone_%%�i?:"."!fO Address____ -------------� � Contractor's Name -------------------- ��`-. ........... •---• ------ -• ............ Phone//n'_= } Installation will serve: Residence Apartment House ❑�� //Commercial E]Trailer Court ❑ Motel ElElOther Number of living units: /------- Number of bedrooms Y---- Number of baths --- /--- Lot size _X- ... AX�__ Water Supply: Public system K Community system ❑ Private ❑ Depth to Water Table4.57,ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ 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.) ; Septic Tank: .14& Distance from nearest well_________________ Distance from foundation -------------------- Material _..__________________________•-•-_______---__--- ❑�IS-E No. of compartments -------------------------- Size --- ....-------•----------------Liquid depth -------------------------- Capacity --•-------------------- Disp�o�sal� 5ie,�ld: Number ofol Re5earest well==----- -- .____ Length of from lin------------------------------ foundation�-.__.`..._.Distance to nearest lot Gne________________ k �� Width of trench ------------------ ------------ •r Type of filter material ------------------------- Depth of filter material ----------------------- length ------------------------------------------ -Seepage Pit: Distance to nearest well- _10_t/___Distance from foundation ---------------- Distance to nearest lot line ___=__4�__ Number of Lining material ---- AR ►_&llL,Size: Diameter-_ ---------- Depth__' .t Cesspool: Distance from nearest well ----------------- Distance from foundation ------------ .------- Lining material ______.___________________-_-_-_--- ❑ Size: .Diameter------= ------------------------------ Depth ---------------------------------------------------- Liquid Capacity------------•---------------.9als. Privy: Distance from nearest well ------------------------------------------------- Distance from nearest building ------------- .--------------------------- . W El Distance to nearest lot line---------------------- I Remodeling and/or repairing (describe)------------------------------------------------------------------------------- --------------------------------------------------------------------------------------- ----------------------------------------------------------- ------------------------------- --------------- •--------------- ------ v-------------- --------------------------------------------------- ------•--------------- ------•---------•-•--------------------------------•-------------------------------------------------------------------------------------------------------------------------------------------------- Fhereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. Owner and (Signed) s-------------------------'-------------------------;; ------------------------------------�----------------------•-------------------------------•------------- - ( ,/or Contractor) By:.---•------------------------ -----------------------------------------------------------------------------------------------------(Title)-----------------------•------------------- --------------- (Plot plan, 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- y ----------------------- ---------------- DATE --------------------------------------- REVIEWEDBY ------------------------------- ----7--------------------------------------------------------------------------------- DATE --- BUILDING PERMIT ISSUED ------------------------- --------------------------- ------ DATE -------- _s . Alterations and/or recommendations:-•-------- ----------------- ------•------ -------------------------- •......... ..._..------------- -•----------•-- E __________________________________________________________________________________________________________________________________________________________________________________________________________________________._ __ _____________________________________________________.-.--________-_--_--.-__-_._________-___-_-.___.--._____._.-_____-_-_____-__--__.___._.._---__._._--___._____.._____.-.____._._______.__--_---_-__________-____- FINAL.. INSPECTION -------------------------------- Date --------- -------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES -9-2M ; Revised W-2100 fi