5540 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. ate) l D i t l C ( ompee n Duplicate) / I 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 Ordinaan`ce No:•549.'' �J/S � JOB ADDRESS AND�OCATION------------------- ------�1.J_S .T0--f----.._..._Itt !h- _IGLU --------------------------- - ------------------------------ Phone------------------------------------ Owners Name_______ Address -' - -- ------------------------I -----r- ..e-- c•----I = Phone----------------------------------- Contractor's Name. Installation , will server Residence g, Apartment House,❑—Commercial,❑Trailer Cort ❑ Motel ❑ Other ❑ Number of liv /C3 C3 ing units: _-��___ Number of bedrooms _�_ Number of baths __f____ Lot size ______________.______;__ __________________________________ Water Supply: Public system Community system ❑ Privat6%E] Depth To Water Table -------- ft. ¢ Character of soil to ( depth of 3 feet"-.Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam,❑ Clay ❑ Adobe W/ Hardpan ❑ Previous Application 'Made: Yes 0 No ❑/ New Construction: Yes Of KNo [� TYPE OF INSTALLATION AND SPECIFICATIONS: [No septic tank or cesspool permitted if public sewer is available within 200 fee+.) 1 "`` ' Septic Tank: Distance from nearest well___�T --Distance,-from-foundation_._i_Q_.__ ___.Material__ __ __________ __ _ ___ _ _ 'Y ----K.•S. Liquid depth�'S - -___.Capacify--------- • ------- No. of compartmenfis-_____._------------.....Size._______ __� - a a© !n I -e Disposal Field: Distance from nearest welL'' ^�-i7istance from foundation--- A0 to nearest lot I�� -S________ Number of lines_---____l _ - -____--Length of each line---------- = _ �----width of trench_________ ______r____•----_----- i Type of filter material_ Depth of filter material_----_.__f ____Total length----------------------------------------- See pa Pit: Distance to nearest v�ell....`.=_Distance from foundation----/G�___s. __.Distance to nearest lot line__ _____________ Number of pitsf_____ ------ _Linin, -matetial�r �.___ Size: Diametert�-. d_`!------Depth- sC �' -_�4 1 Cess col: Distance from ,nearest - g �1' Cesspool: well_________________Distance from foundation____________..__-t_Lining mateial__._.______---__-__._____._-________. 9 ❑ Size: Diame#er �7.. w" " Depth__-r -: - ---)-Liquid Capacity -------gals. Privy: + l-______________________ _______._, __Distance from nearest building-- =-__-________________-_____�______.- Distance from nearest well . Distance to -nearest'lot line-------------------------------------------- - -------------------------- -----------------------i----------------------------------------- El �1 Remodeling and/or repo ng (describe}---------- -------- 1 ---------------•---- -------- ------------ --- i, --------- --� --is-,,..1 .�-.. . 1+ ► .' 'tS : - -------------- -- ---------•------------- ------------- ---------------------------• ------•--------•----------------I---- ---------------------- ---------------------------------------- ---------- I hereby certify tha+ I have prepared this application and that the work will be`done in accordance)with San Joaquin County ordinances,VT4 to laws, and rules and re ulations of the San Joaquin Loci Health District. /� Si ned �f!! /F `t --------------------------------------- [Owner and/or Contractor] By:--- ---------------4-------------•_.---------.... ------------------ - (Title) g (Plot plan, showing size of lot, location of system in relationt. o wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_:------------------ ----------------- -- ------------------------------- DATE ---------------•- REVIEWEDBY------------ ---------------------- --------------------- DATE...------ --------------------- BUILDING PERMIT ISSUED _ _ T— — ---- - DATE------------------ -•- -.•----------------------_-.----_.._. -� ----- Alterationsand•/br recommendations----------------------------------------------- ----------------------•----------------------------------------------_-----------•-------- -- -.....--------- ----------------•------------------------------------------------------------- ----------------------------------------------------------------------s----------------------------- ---------------------------------------------------------...... -------------------------- FINAL INSPECTION BY: - S tDate._--- r, yds ------------------------------------- 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-4-2M ; Revised W-210D J