12999 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. 1'r�.-_9..1?,y (Complete in Duplicate) Date Issued ____ This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This-applida- ion`is'made in compliance with County Ordinance No. 549. J013,ADDRESS AND LO TION --- --- -- � Owner's Name - ------- ---•-- ---- -- ---- ------- -------- Phone--------------------------_------•-- I Address -------------••-•----•-- t ------ Contractor's Name--- ±•-r-------------------------------------------------..------------------- ------------------------ ------------------- Phone................................... Installation will serve: Residence 0 Apartment House E] Commercial Commercial [-] Trailer Court E] Motel E] Other E]Number of living units: _ ___._ Number of bedrooms ._1----- Number of baths -1...... Lot size ___ "OL-0_0__________________________ Water Supply: Public'system Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of.3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam,® Clay ❑ Adobe ❑ Hardpan _ " Previous Application Made: Yes ❑ No New Construction: Yes rf No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank'or cesspool permitted if public sewer is available within 200 feet.) Sept Tank: Distance from nearest weli___�0-----Distar�e,_fr�m undation---I_0---------Mart�erial____ _ ______ _________- No. of compartments_----�-----------------Size--l-------`-----K----------Liquid depth------- ----------------Capacity---- } Disposal Field: Distance from nearest well_-_D-_____Distance from foundation---2-_0_*-------Distance to nearest lot .y� ----------------- Width of trench...?o --"---------------------- Number of fines______ ____ _____ _ __ _ __ Length of each line___l� . Type of filter material�,r4 Depth of filter material -Total length________ i7 "_____________________ Seepage Pit: Distance to nearest welt__--------------------Distance from foundation------------------- Distance to nearest lot line______-.__--___.. ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth--------------------------------- I Cesspool: Distance f,•om nearest well _________Distance from foundation--------------------Lining material---------_._._-.._..-_--__-_____..._ ❑ Size: Diameter--------------------------------------Depth--------------------------------------------------•-Liquid Capacity----------------------------gals. Privy: Distance from nearest well--------------_------------------- ------------__Distance from nearest building_..._._._-___-_______________..__..____._. ❑ Distance to nearest lot line-----------------------------------------------------------------••--•----•------------------------ \� Remodeling and/or repairing (describe)=-------------------------------------------------------------------------------------------------------------- -- -- --- --- --------------------------------------------------------- ------------------------------------------------------------------------------- I _.._____..________________.__________--__.__________.____-______--.____..-____________._--____________________________________._______-______-____-___________________-_--.___.--____.__._______________-___--_____________.- __________________________________________________________________________________________________`------------------------------------ ._______ + I hereby certify that I 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 Cantractorl By:-------------------------------------------- ---------------------------------------------------------------------------------------(rile)---------------------I)----------------- -- - ------- - --- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on revrse side). FOR DEPARTMENT USE ONLY l APPLICATION ACCEPTED BY____ DATE____-_-_ l_______--____ ----------------------------------- 6_ - - -- ---------------- IREVIEWED BY------------------------------------------- - --------- ------------------------------- ------------------------------------- DATE------------------------------ BUILDINGPERMIT ISSUED---------------------------------- ------------------------------------------------------------- DATE------------------------------------------------------------ Alterations and/or recommendations:--------------------------------------------------------------------------------------------------•-------------------- -----•-•-•-----------••------------ ----------------------------------------------------•---------•----•------------------------- ------ -I---------•-------•-----------•-------•--------•----------------------------•------------------------------------------ -----•---------------------------•------------------------------- ----------------- ---------------------------------------------------------------------------• -----------•------------- --------------------------------- ----------- ------- ------ --------------•------------------------------------------------------------------------------------------------------------------------------ --------------- ----------------- -------------- ---------------------------------------------------�-------------------------------------------------------------------------------------------------- ----------------------------------------------------• -� 1� I FINAL INSPECTION BY�- _____.___. Date---- ._ .'� r' SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street i Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 8-'59 F.P.Co.