4957 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. ._��_ __- '_7 (Complete in Duplicate) Date Issue __ __Y_______ 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. / J JOB ADDRESS AND LOCATI ,N.._---W'----.-i _P_ J__ _ ^_d_ ._.--•--- - - .- --- -- °v-- - _�----- �� Owner's Name ---------------------------------fc r _ � ��------------------------------�-�-�- ----- --------- ---- -------------- Phone----�--�------�b-----�--��--- - ----------------- ---- Address------------•-- �� rr` ---------------- Contractor's Name-------�C i C x -C- � l'T _ ------------•------•------------- Phone----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ____�_ Number of bedrooms _ Number of baths ---'7—Lot size --_ o 7.-___-_____ Water Supply: Public system ❑ Community system ❑ Private 2--`5epth to Water Table o'-F-0. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam UT-101ay Loam ❑ . Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No [ New Construction: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet Septic Tank: Distance from nearest well____� ---Distance from foundation_-_�______--------Materi --------7,_ Z' - ----- - - ------- -- - ----- I No. of.compartments-------Zr------..._Size------•-----------------•-------Liquid depth ------ ---------------Capacity-- --- L_ / I DisposaL-Field: Distance from nearest well... 5---Distance from foundation___.' Distance to nearest lot line,--t/ d Numb`eT of lines-.________ 71 --Length of each line_________ �y.� Width of trench. ----------- Type Offfllter materia( -----.Z------Depth of filter material-------f.i� ___._Total length--------�d____-�"�~ .-_________ Seepage Pit: Distance to nearest well-------------------- -Distance from foundation--------------------Distance to nearest lot line----------------- F-1 Number of pits----------------------Lining material--.--------------------Size: Diameter---------------------- Depth-.------------------------------• .� Cesspool: Distance from nearest well--------------_Distance from foundation--------------------Lining material-_________________________---__---- 'rte Size: Diameter------- - De th ---------Liquid Capacity------------------------------------ Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----------------------._______.__._______- ❑ Distance to nearest aot line-- ------------------------------------------------------------- ------------------------------------------------- ] Remodeling and/or repairing (describe):-------------------------------------------------------------------------------------•-- ---------------------•- -------------•--------------------- ----------------------------------------------•---------------•--------•-•--------------------------------•---•--------------------------•----------------------------------------------•----------------------------------- -----------------------------------------------------------------------------------------------------------------------------------......--------------------------------------------------------------------------------- T� - ---------------•-----------------------•-------------------•------•-•--------------------•--------•----------•---------•----------------------------•--------------------------•-----•-----• ----------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, to I -nd toles and regulations of the San Joaquin Local Health District. (Signe - -- -----------•------------------------------------------------ ------(Owner and/or Contractor By:---------------------------------------------------------------------------------- -----------------------------------------------(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---------- ----- --- F�- -- --------------------- DATE- J��' -------- REVIEWED BY---------------------------- -- --------------- - -----•------------------•- ---- --------------------------------- DATE-------------------------- BUILDINGPERMIT ISSUED-------------------------------------------------- --- ----------------------------------------------- DATE------------------------------------------------------------ Alterations and/or recommendations:---------------------------- ------------------------------------------------------•------••----------•--------•----••-•---------------------------._.. ---•------------------------------------------------------------------------------------------------ -•----I-----------------------------------------•-------------------• -------------------------------------------------- ---------- ------------------------------.-------•---------------------------------•--•------------------------------------•--------•-------------------••-------------- --------•---------------------•----------------------------- .- FINAL INSPECTION BY:. ------------------------------- Date--------------------------- --------- -- �j in wnj N LOCAL EALTH DISTRICT 1jL0 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 �.- 1