6148 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) 3 Date Issued __ ___/ --- 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. JOB ADDRESS AND LOCATION _ _f-•_�v- _-------�!----,�� _ Owner's Name_.., Phone Address - - --------------•-- = Address__.- Contractors Name.....A-4:*-- - Phone�2,'2 � Installation will serve: 'Residence g4—Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [❑ Other ❑ Number of living units: __ ___ Number of bedrooms Number of baths . _.. Lot size--____ 1�----- _- -©_-� Water Supply: Public system '�munity system E] Private E] " Depth to Water Table � 'ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobeardpan ❑ Previous Applicafion Made: Yes ❑ No w' Construction: Yes ❑ No 9; . TYPE OF INSTALLATION AND SPECIFICATIONS: [No septic ank or cesspool permitted if public sewer is available within 200 feet.) ' �•f "$ Sep is an Distance from nearesi well------------ fro fou dation------------------- ria)___ Liquid depth---------------------- - Capacity�No. of compartments----------- -----____Size____... �(_S __ 7 posal Figld• Distance from nearest well-----------------Distance from foundation_--_.____-_____..__Distance to nearest lot line----------------- r "a Number of..lines..... ----------------------------Length of each line--'--------------------------Width of trench-----•-------------------`------_--- N Type of filter material_________________________Depth of filter Material-----------------------Total length--------------------____-.----____________ Seep e, Pit: Distance to nearest well___________________-Distance from fo ndation___ --6-fIsfa�ce to nearest lot line_ ---------- Number of pits.__.-_._-.___.___"Lining material_ ; _.Size: Diameter__ �� Cesspool: 'Distance from nearest well-----------------Distance from'foundation_________----------_Lining material-_-___._-.__--____._____---__.______- Size: Diameter----------------- --------------------'De th--------------------- ---- -- ~---- Liquid Capacity gals. ❑ p -:Privy: Distance from nearest well----------.-------- ----------------------------Distance from nearest building_______--_._______--.----_------:-_-_--- ❑ t - _. D�stance'to nearest lot line.-.--.- F --------------------------------- `------------------------'---------"---- r Remodeling and/or repairing (describe) '- -----------------------------------------------------. ..::.--------------------------------------- •-•---------------------------=--------- -----------•----•----------------------••----'--------------------------------------- --•--••----------------------------------- •--------------------------- ------------------•------------•---•--------------------------- ------------------------- ------------------------- --- --•---------------------- -------------•-•----------------•---• ---------------------------------,---------•-----------•----------------------- 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, and ules and r guiations of the San Joaquin Local Health District. I Contractor)------------ [ r(Signed)----- . --- , .... 8Y' [Title) _ '_ ------------------- ------ t (Plot plan, showing size of lot, location of system in relation to-wells, buildings, etc., can be placed on reverse side). r FORDEPARTMENT USE ONLY APPLICATION ACCEPTED BY --- ------------------------------------------------------ DATE------ --------------------•---- REVIEWED BY-----. ------ V•` DATE ----------------------------------- PERMIT ISSUED ------ ------ - DATE - ---- BUILDING ' f ---------------------------- Iter ions nd o rec mmendations: / X ---- -•-� '! ►� yt --------------------------------- -------------------"---------•------------------------ ----- 0 '-----------0- ----------- -------- --------------------------------------------•--------------------------------------•-------------.----------------I---------- 9 3 :sem FINAL INSPECTION BY:----- r._.--- y -----•--------- Date---- '' ------ ----- ---- �` `= i = 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