5457 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit (Complete in Duplicate) Date 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. _ JOB ADDRESS AND, LOCATION-ly--a--Z-- .--- ------------------- �• 9 Owners Name-- -•-• •..... ' -----------0 Phone -- °- ------- - ----- Contractor's Name 1 -'°-� -------- �f / Addres --- ---------- Phone-t-,--- .----- Installation will serve: Residence J Apartment House ❑ Commercial ❑ Trailer Court ❑ 'Mot I ❑ Other r� / Number of living units -- ----- Number of bedrooms __�±- Number baths ___t--- Lot size _-_ `/C_/ 1_ ,-__-------- Water Supply: "Public system•❑ Community system'❑ -Private g Depth to Water Table __-- ft. �i Character of soil to a do pth of 3 feet: Sand [-] Gravel E] Sandy Loam E] Clay Loam E] Clay E] Adobe E) Hardpan E)Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank'or cesspool permitted if ubl�ic� se_.w�er�is available within 200 feet ' Septic dank: Distance from nearest well-_„D-__ ._.Distance ,from fpunda i n-_- -----_- at i�i----------------- =..w.. No. compartments / • S1z (_jl Liquid,�eptli Capacity --� r Dispos Field: Distance from nearest wellQ- isfance from.;foundationA0--!r`-_-[3istance to nearest lot lirteTf-------------- Gr'"'L'� Number of lines------_- ength of each line------------- fe Width of trench---__ ------ �� v Type or filter materia------ --------- ------- epth of finer material------ --C]---------Total length-----_-.--..�_- _0- _ Seepage Pit„— _"Distance to clearest well----------------------Distance from foundation-------_.=....._-_.Distance to nearest lot line----------------- O ❑ Number of pits-_`-------------------Lining ma :_ terial----------------------.Size. Diameter------_--.------------Depth .----------------.__- _-------- 1f i W Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- El Sizer Diameter- = ---= ----.Depth------------------------------------ -------- ----Liquid Capacity----------------------------gals. + Privy: Distance from nearest yell----------------------------------- .-.---__.._.-Distance from nearest building--------------------------------------- ❑ ._. + l a .. �..-,--Distance to nearest lot line----===------------------------------------ - --------------------------------------------------------------------------------------- � Re odeling and/or repairing (des _vibe):------ '------ - -------•------•------ t. .� -.4 - r -------------- ------------------------ ---------------------------------------------------------- -------------------------------------•----------------------------------------------------------------------------- tY i - -----------------------------------------_---_--------------------------------------------------------• --------••------------------------------------------------ t hereby certify that I have prepared this application and that the work will be done .in accordance with San Joaquin County II ordinances, State laws'and rulesand,reulations of the San Joaquin Local Health District. I' I (Signed). . _- = _4__1- ------------------------------------------------------------------------------------------------=(Owner and/or Contractor) By;.....------- : - ---(Title)-------------------- (Plot plan, showing-size off;lot, location of system in relatian-to wellsrbuildings,"etc.;'can be placed on reverse side)."- FOR DEPARTMENT USE ONLY ..�. APPLICATIONACCEPTED BYQ------- ---- --- ------------------------- --------------------------•------------- DAT��,---------••------------------------ REVIEWED BY DATE _!�--------••----•-------••---•------------------- BUILDING PERMIT ISSUED T- -------------------...-------•---------------------------------------------------. DATE..----- Y1— A P !r r f Alt af atioJns and/or r commendations: - -•------------- {------------------_--•-•-•--------------------- - •------ ------4 ----- ------ ------- - Ali ----------------------- --- e_ r "" -------------------------------------- --------- -• -• ..... r------ 1 Y FINAL INSPECTION-BY:.-------- `' ----•- ---•--------•--------=-- Date------------------------------------------------------------------------------- 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 Revised W-2100