5346 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. �3- (Complete in Duplicate) Date Issued Applica+ion is hereby made to the San Joaquin Local Health District fora permit to con l This application is made in compliance with County Ordinance No. 54 p strut+ and install the work herein described. JOB ADDRESS AND,-OCATION ----•- Y Owner's Nam Address-- ------------- --- ---------- Phone--- -- -------------- ----------------------- --------- - - --- --- --- --------------I-----------------------•-------•----------- ----------.---- --------- •-----•--- Contractor's Name_____ ________ Phone. Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ----------- I Number of living units: Number of bedrooms „�-- Number of baths -� ❑ '�Motel ❑ r Other� a ___- Lot size --- c: Water Supply: Publis stem -------------- Y ❑ Community system ❑ Private Depth to Water Table�Gft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam E]. Clay L-] Ado ❑ Adobe Previous Application Made: Yes ❑ No f� New Construction: Ye�Iw No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool perinitfed if public sewer is available within 200 feet.) - Septic Ta Distance from nearest well_________________Distance from foundation-------------------- ° ------------ MaterialNo. of compartments---- --------°-----------Size ------------------ --------------- --------------- quepth--------------- --------- Capacity---------------------- isposal Fielo. 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 m ----------------._---__--Depth of filter materral___ --- -------- --------------------Total length--------------------------------•------ Seepage Pit: Distance to nearest well___-I(Oe ---_Distance from f ndation___,Zff5.1_�---.,Distance to nearest lot Number of pits___-_-----------Lining material - -_ --- _- -�_-_size: biameter____ • � ----_.Depth-------- Cesspool:, Distance from nearest well-----------------Distance from foundation___,_______________ Lining material_--- ❑ Sjzei Diameter--------------------------------------Depth--------------------------- --- Priv - --------------- Liquid Capacity-- -----------------------.gals. Y: Distance from nearest well '__-_-T _-.--_-Distance from nearest building r --------------- ----- g------ ----------------------------------- ! ?S ❑ Distance to nearest lot Ime._._____.___ _ - --•----------------•--- ------ Remodelin and/or repairi g (describe):__- � --------------------------------------- ------------- ----------- ----- -------- ------------ r --- -- --------• _ - I hereby certif- fhat I have prepared this application and that the a k will be done}in actor ante with San Joaquin County' ordinances, S aws�aan 'rues and re I ions of the San Joaquin Local Health District. (Signed)------ ---- -- - d!_..._ - ------------------------ (Owner nd/oe Contractor) Plot Ian, sho �n siz !"ot, location -- -- s --- k ✓ -- - _ - ____-.Title _ ___ _ _ _____ t` --- --- ( P g of system in relation to wells, buildings, etc., can be p ed on reverse de), ' F' y FOR DEPARTMENT USE ONLY 1 APPLICATION ACCEPTED BY #o -1- 11--- -------••--------------------------------------------- DATE-------°*----- - VIEWED BY---- -------- � .... - �". ------------- - --- - --- DATE---�--•---- � - ---------------------- --- ----------------------------------------------------------- ---------- I �v,� ----------------- BlJILDING PERMIT ISSUED__._____---_v --------------------- -------------- -------------------------------------------- DATE-.-----------------•--------------;-----� Y Alterations and/or recommendations:--� ---------------- --- ------------------ -------------------- •------- •---F? --- ------------------- ----------------- - ----------------------------------- ------------------------------- - FINAL INSPECTION BY__________________ _ Date_ --�=- --------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wes} Oak Street 132 Sycamore Street Stockton, California 814 North "C" Street • Lodi, California Manteca, California Tracy, California # � E5-9-2M ; ' Revised W-210D