4594 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. _... ........ (Complete in Duplicate) / Date Issued -�-,[ '? .3 A licati is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein/described. i This application is made in compliance with rC�ounty Ordinance No. 549. JOB ADDRESSL CATIO / / -------- Owner's Name... lr _- _ _ --------------- Phone_- � _5?Y Address------- ---- I f 7 Contractor's Name----------------- ------- `----- ---------------------------- --------------------------------- Phone___,Q/—1,2 ------------------ Installation will serve: Residence/ 0< Apartment House E] Commercial ❑ Trailer Court E] Motel E] Other E]Number of living units: _L____ Number of bedrooms __ - Number of baths Lot size _14.a__,-__--- S"`D Water Supply: Public system ❑ Community system"El" Privste';K `Oepth torWater Table /0__ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sancly Loam ❑ Clay Loam ❑ Clay ❑ Adobe• Hardpan ❑ Previous Application Made: Yes ❑ . No l$ New Construction Yes X No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ptic Tank: Distance from'nearest well—------1------Distance from foundation--------------------Material ------------ No. of compartments----I-------I------ ------Size--------------------------------Liquid depth_-------------------------Capacity--------------------- {s sal eld: Distance from nearest wel!---4�-s�-___Distance from foundation_____�,Q-__---Distance to nearest lot line____ Number of lines.--------1 Length of each line---- 140-�-- --------Width of trench.---- ' YN ; Type of filter material-sf_ 44 Y -Depth of filter material___._ _ .t� Total length ®� �1� ------------------ Seepage Pit: Distance-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---------------------------------- F1 Sizer Diameter ---------------------------- ---------Depth------------------=----•-------------- - --°------Liquid Capacity----------------------------gals. Privy: Distance from nearest well--------_-----------------------------------------Distance frorn�nearest building ---•---------------- Distance to nearest lot line:-:_- " Remodeling and/or repairing (describe):---------------------------------- -----------------------•----------------------------------------•---------------------- -------------- --------------------------------I-------------------------------------------------------------•-------------------•----------------------------------------- ----------------- --------------------------- 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)------16� _�` _-A -------------------------------------------------------�'�'------------ - _____________________________�_.. ___{Owner and/or Contractor) By: --- �� (Title)- _ (Plot plan, showing size of lot, locati�_. fystem in relation to wells, buildings, etc., can be placed on reverse side), FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY-----------------=-------- ------------------------------ ------------------------------ DATE------------//BY--------------------------------------------- -------------------------------------------------------------------------------- DATE---------------------------------------------------- ------- BUILDING PERMIT ISSUED------------- --.----------------= -------------"-='-------- - --------- ^------------------- DATE- Afterations and/or recommendations:___�-- --- _ ----- ---------------------------- - - . .. ----------- --- -----------i -------- ----------------------------------------------------------------------------------- ---------------------- ------------------------------------------- - --------------------------------------------------------------------•--•------------------------------------------- -------------------------- r ------------------•----- -----•- -------------------------- - ---------------------------•-------------------------------------------------------------------------------------------------------------- FINAL INSPECTION BY--- ---------------,�-fl---- -x? Date------ /"-� r� 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-9-2M I0-52 Revised W-2100