3540 - Laserfiche WebLink

Home Browse Search

. r t APPLICATION FOR SANITATION PERMIT Permit No. ------`U yty�� (Complete in Duplicate) Date Issued .__ 3 U Application 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 Ordi ante No. 9, j JOB,.ADDRESS AND LOCA N--- --�---�/_.-- -- -'--- -- - --- - � -- ---- ------------------------------------------------------------------------------------- Owner's Name---------------- ---- -=-------------- - ---------------------------------------------- Phone---------------------------------- - f Address--------------------- 1� _ ...:-=....... -------------- - ------ ------------ ----_ Contractor's Name----------- [} �A- "------ - 'c'----- �r - ---------•-------- Ph( ne__1- --- -------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Mot I ❑ Other El Number of living units: __ __ N mber of,bedroora, ___L._Number,�,of baths .�_---- Lot size ---___�-x.�__�:__�__ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table_ ft. ,Character of soil to a depth of 3 feet: Sand ravel-E] Sandy Loam lay Loam ❑ Clay ❑ Adobeardpan ❑ 4' Previous Application Made: Yes ❑ No New Construction: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if'�puublic/seer is available within 200 feet.)Septic Ta Distance from nearesr we�ll!'d istance-_from foundation__ !�__._____..Mater'al .- I �+ cit -a No- of compartments___ --- ___ _ ize..,�,x./��___,___Liquid depth__- ��.-._____._Capacity...._ Disposal F' Id: Distance from nearest e!#./� __ _Distance from faundation../ Q�---------Distance to nearest I� line__ ----'-. { Number o.r lines------ Length of each line_ Q �_-.Width of trench,e _______.___P--- Type of filter material-�_ Depth of filter material---2 _!--- ___.Total length-------------- --.0--____.__--_- Seepage Pit: Distance to nearest well___-----------------Distance from foundation__-----------------Distance to nearest lot line--__----___--_--- ❑ Number of pits------------------.-Lining material-------------------- ameter-----------------------Depth----- ------ ----------------- _ t �\ Cesspool: Distance from nearest well----------------- from foundaon-- - ----------------Lining ❑ - material----_-.-______._____-_._____---.- Size: Diameter--------I-._.- -----------------------De th---------------------------------------------------Liquid Capacity---------------------------gal;.. .1 i Privy: Distance from nearest yell___________ -------------------------- ------------Distance from nearesr building-_____________________________. � ❑ Distance'to nearest.lot line ----- ------ --- Remodeling and/or repairing (describe -- ------ ------ -------- -- - --- _- .-- ---- -- .-----.._.T-.---__- -- ----------t----- - -------------------------- -----------------------------•-----•--------------------•---- -------------------------------------------------------- - - ------ 2 ------------------------------------------------------------ -------•------------------------------ � qq t-----------------------------------------------------------------=-----------------------------------------•------------------------=-------=------------------------------------------------------------------------------ 4 I hereby certify that I have prepared this application and that the work will be`done in accordance with San Joaquin Cou ordinances, State laws, and "rules and r6 gulations of the.San Joaquin ocal Health District. (Signed)-------{/j 1 = - --(Own and/or ontractor) By. - r� y� z ------------------------------------------------------------------------=---(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----------------------------------------- _ _-- DATE------------__- REVIEWED BY-------------------------- ----- f �----------------- BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE----------------------------- - ------------------ Alterations and/or recommendations:-----------------------------------------------------------=---------------------------------------------------------------------------------------•--------.. ---------------------------------------- ------•-----••-------- - ------------------ •--------------------------------------------------------------- ----------- --------------------------- -----' } ------------------ ----------------------------------------------------•---------------------------------•-------------------------------------------------- ------------------------- l FINAL INSPECTION BY:.. � > Dafe -, SAN JOAQUIN LOCAL HEALTH DISTRICT "a. 130 South American Street 300 West Oak Street 132 Sycamore Stree! 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ;y' ES---4-2M 14-52 Revised .W-2100