5234 - Laserfiche WebLink

Home Browse Search

l APPLICATION FOR SANITATION PERMIT Permit Nos.---_. .- i (Complete in Duplicate) Date Issued --_ 1-- -- �� _ r 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. ' --------•• - ---------------------- ---ADDRESS A CATION----- - - - ----------- - _ Phone Owner's Nam ----------_---- -------- ----------------------------------- , Address._. - ------ -----•------------------------------------------------------------------ ---- ---- ------ �° " Contractor's Name----------- -- ---- ---- ------------ --------------------------•----------------." Phone -• -- • '"---- --- �- ----- Cher Installation will serve:. Residenc� Apart K House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Number of living units: __ --. Number of bedrooms_ Number of baths/---- Lot size _-- -------------------------- J y Water Supply Public system '. Communi+y system ElPrivate Depth to Water Tablet Of+. 1 ' 1S ` ! Character of soil to a depth of 3 feet: ►Sand E] Gravel ❑ Sandy Loam [I Clay Loam ❑ Clay El Ad .Hardpan E] Previous Application Made: Yes [INc New Construction: Yes No [I TYPE OF INSTALLATION AND SPECIFICATIONS: 4 (No septic tankor cesspool permitted if public sewer is available within 200 feet.) s . Septic Ta Distance from nearesr well----___---- Distance from foundation---------- ----Material_.`__________ .-----_-.---------------------- t a No. of compartments......... .. ......---Size-----------------------------=-Liquid depth------------------------ Capacity-•---- ---------------- Disposal Fie! ,Distance from nearest well...__--.---."'Distance from foundation----_--------------Distance to nearest lot line----._-..------_. 'Nurnber.of lines-------#---------=----------------Length of each line_--------------------------- Width of trench Type of filter materiel------------------------=Depth of filter material....-------------------Total length-__---_""----------------__-------------- _ 1~! y _.____..Distance to nearest lot line---------- ----- Seepage it: istance-to nearest well..-.-/ '' '-Distence'fr fou anon-= ' IDS,umber of•pifs-. 4 --Lining materia �-------- ow p � �y iP" --- NumberSize: Diameter ---_- De th--- ---- a r ,..� } S Cesspool: Distance from nearest well-_--------------Distance from foundation-----_____--.-.-----Lining material _ _ .------ ----------- --------------- Size: Diameter { -Depth----------------------------- ----------------------Liquid Capacity---------------------------- t 1 I Y Priv Distance from.nearestrwell------------------------------------------------ Distance from nearest building---.-______________-_-_--'----------------- y:. ❑ _ T Distance to•nearest lot line-- _---- ------------------ ---- ---------.----------------------- - ------- ------------- - Remode' g and/or epairin (descr e:- r ---•• = ` - f # ------------------------ -----------l--------- ----- ----- t. -,----------••-•------•-------------------------------------•------------..------------------ ------------------------------------------------------------ I hereby certify that I have epared this application and that the work will be done in accordance-with San Joaquin County ordinances, S laws," a fru s and regulatio of the'San Joaquin Local�Health District. i n Contractor) (Signed)_ ---- ------- -- --- ------- ---------- ----------------- (Owner Cont or ' -----------------------------------------------------------------------------------------(Tit -- ---- `•- - - (Title) -- (Plot plan, showi ile of to , location of system in relation to wells, buildings, etc., can be d on reve a side): R i FOR DEPARTMENT USE ONLY •� l APPLICATION ACCEPTED BY__-."_ -- -.- -_ - _.-V'� ` -------------- DATE-----�_ - -�J""" --------- ,W REVIED BY i �.. ----------------------- DATE--------------------•------------------------------------- - -------------------- BUILDING PERMIT ISSUED + ---------------------------- BATE Altera#io s and/or recommen ions:._ �� y-_ ' - Of --------------------------------------------------- -- - ----------------------------•-------------------•----------- 6-7--o'Y - FINAL INSPECTION -BY:------- ------------ • ---i- - Date =` SAN JOAQUIN LOCAL HEALTH DISTRICT \ 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C'.' Streef Stockton, California Lodi, California MaMoca, California Tracy, California ES-9-2M Revisad W-2100