6736 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) i p . ... � � Date Issued Pf pplica*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 Cou fy rc finance No. 549. JOB ADDRESS-AND'LOCATION .--�--�L- = - - Owners Name°° 'I _ 1A_,_.. -.__.. �. Phon2 - .��- �r C� (tt` + t Address----------- '"`."e --------- ----------------------------------------'----------------------------------__-- Contractor's Name------- -----------=---- ------------ -- -------------------------------------------------------------------------------------- Phone-------------------- , -------------- ./ Installation will.serve: Residence EVr1*1`Apa men-t House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living un fs: ___�____ Nurn ber Tof bedrooms _ NumVDepth!fo. baths __ Lot size ____ _ - ______________________ Water Supply: Public system ❑ Community. system .❑ private. Water..Table _____ ft. Character of soil to a depth bf 3 feet: Sand E] Gravel E] Sandy Loam Clay Loam Clay E] Adobe E] Hardpan E]Previous Application Made- Yes [:] No V New Construction: Yes No ❑ TYPE OF INSTALUATION'AND-SPEC IFICATIONS: 1 (No septic tank or cesspool permitted if pubL Se tic ark: Distance from nearest wellf��.c sewer Es available within 704 feet.) p T Distancelfrom-fo - ------------------------ - . No. of compartments.---------- _.�------- Liquid d p+h'-- --------------Capacity-- - - . Disposal Field: } Distance from nearest well ._::._____.Distance from foundation_1_0�rDistance to nearest lot line' `• ® Number of lines_________ __- ength of each line_/_d_Q-.+�f1:� �/Vidth of trench____________lae _ .: --- �l Type of filter mater _ __._ ____ Depth of filter�materai_______f._9__f-----Total length__________ _- - -------------- _ Seepage Pit: Distanc.eM to nearest well----------------------Distance from foundation---------------------Distance to nearest lot line----------------- ❑ Number of pits----------------------Lining material---------------------- Size: Diameter------------------------Depth---------------------------- -- _-. Cesspool: Distance"from nearest well-----------------Distance from foundation------------------Lining material_________________._.__.___________- (' ❑ Size: Diame+er- -=---------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals . ]r Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-_----------------------_.--___-__-----_-. [� ❑ _ Distance to nearest lot line----- ...:--------------------------------------•--------------------------------------------------------------------------------------------- Remooeling and/or repairing (describe):-------------------------------------------------------------- ---------------------------------•-------------------------------------------------------- ------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------- --w.. - - . -------------------------------•--- ------------------•------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that 1-have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State-laws, and rules and regulations of the San Joaquin Local Health District. {Signed}____.,_..,_- -*�-• ------------------ _ .____(Owner and/or Contractor) , 1 By:---------------------- -------------------------------------------- --------•------ •----------•--------(Title)---------------------------•----------------------------------- (Plot plan, showing size oV lot, location of system in relation to wells, buildings, etc., can be placed on reverse.side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- --------------- DATE-may- REVIEWED BY------------------------------- DATE BUILDINGPERMIT ISSUED--------------•-----------------------------------------------•--------------------------------------- DATE-----__- ------------•---------------------------------- Alterations and/or recommendations:.---`------------------------------------------------------•----------- -----------------------• -----.....------- -------------------•------------------- -----------------------------------------------------------------------------------------------------------------------------------------------------------------•-----------------------------------------.......•-------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------- .. t • ---------------------- ----•---------------------------•------------------------------------------------------------------------------------•-----------•----------------------------------------------------•---.....-_._.. --------------------------------------- ------------------• ------------------------------ -------------------------------------------------- ------------------------------------- --------------------------- FINAL INSPECTION BY:_', -------------=-=--------------------- ------------ Date_ ' 8 SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street RStockton, California Lodi, California Manteca, California Tracy, California 'ES-9-2M ; Revised W-2100