3690 - Laserfiche WebLink

Home Browse Search

?j APPLICATION FOR SANITATION PERMIT Permit No. _ ____ _ (Complete in Duplicate) �/ F4A�p!licafion Date Issued - ��_�_ _(�'-c3111 `is hereb made to the San Joa uin Local Health District fora ermit to construct Y q p and install the work herein described. This application is made in compliance with County Ordinance-No. 54.9. . s� JOB ADDRESS AND LOCA ON_______________ __ -•- --------._. :_!?.__.�._ �%"' /� _ = = -----•- -------------------------------------------------------•--- _------ Owner's Name C,' _�L_ � =------------ ------ - ------------ ----------------------------- Phone---•------- Address ...... ----- AddressJ, f = •-------------------------------------••--------------------------------- -- --- ------------------. --.---- Contractor's Name---------------- � 1 �----�`��---------------------------------------- ---------------- Phone �--; 0. Installation will serve: Residence I Apartment`l-louse ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: __ - Q Number of bedrooms ` ./-._ Number of baths . __ Lot size ____ ___ ___ _ __________.___-__.__ Water Supply: Public system�Community 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 ❑ Adobg-k Hardpan ❑ Previous Application Made: Yes E] No Ki" New Construction: YeNo ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) t Septic Tank: Distance from nearest well Distance from foundation. /V--------- a---- _�------- No, of compartments__-_ ___- ----- _ s__!F� ! d d _�iquiepth J--_____Capacity___,'?��a__.__� Disposal Field: Disfance from nearest we€i-----------------Distance from foundation----------------_Distance to nearest lot line----------------- ❑0 Number of lines-------------------------------- Length of each line-----------------------------.Width of trench---_------------------------------- Type of filter material________________ Depth of-filter material-------------.._f.____Total length_________.._______-_----____________--__-- Seepa a Pit- Distance to neatest well.�c Distance fr m foundation_ f -r -- , __.-.___.Distance to nearest lot ex Number of pits_____.__/-_____-Lining material, __Size: Diameter__________________Depth.... u /___._._._ / \ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-----------._________-_____-_--_---- ❑ Size: Diameter--- - -------------------------------Depth- --------------------------------------------------Uquid Capacity----------------------------ga{s. Privy: Distance from nearest well----------------------------------.--------------Distance from nearest building------------------------------ ----_- j ❑ Distance to nearest lot Iine--------------------------------------------------------------------------- Remodeling and/or repairing (describe):----------- --- - ----------------------•-------------------••----------- ------------- ---------------------------------------------aL----------------------- ---------------= -•---------------------------------------._-_...-------------------------------------------------------------------------------- ------------------------------------------------------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State s andrul s. a regulations of the San Joaquin Local Health District. , 4 [Signed}.... Cerci` -..1111- ------------- -------------_--- ----------------------------------- -(Owner- d/or Contractor) By: ; =----------------------•----- (Title)_. Aja {Plot plan, showing size of to`, cation of Sys am in relation to wells, buildings, etc., can be placed on reverse side}. � FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY DATE-- ------------------ --------------------------------- REVIEWEDBY - <----- -------------------------------------------------------------------------- DATE . BUILDING PERMIT ISSUED-------------;�JDATES ---------------•- -- ------------------------ Alterations and/or recommendations--------------- -------------- ----------------------------------------•--------------------------•----•-- -----•-----------------------------•---- -----•-------------------•------------------------------------------------------------------------------- ---------------------------------------- --------------------------------- ---------------------------- ------ -- -- ----- - --------•----------------------- FINAL INSPECTION BY-------- -------- -------- -- -- -- -------- ----------- - Date----- ----------- --- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stock+on, California Lodi, California Manteca, California Tracy, California ES-4-2M 10-52 Revised W-2100