12410 - Laserfiche WebLink

Home Browse Search

1�a APPLICATION FOR SANITATION PERMIT Permit No. (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 application is made in com liance wilfi County Ordin nce No..549._ . �/ - !77 — 2r o.-,o 2_- JOB ADDRESS AND LOCATI N__________ _____ _ ______ __________ _____ -- -------------- -----------. ---------------------------------------••- ------------------------- JI Owners Name _ - ------------------------------------- Phone-----------•-----•---•---------•---- Address---------------------- r --- ------ -----. - Contractor's Name____ _____ ------------------•------------------------------ -------••- - Phone - ------ �. Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: -------- Number of bedrooms ________Number of baths -------- Lot size ____-_._______________________ Water Supply: Public system 2--Commuriit1 system ❑ Private ❑ Depth to Water Table -5;0 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy-Loam [❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes �o ❑ New Construction: Yes ! No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank•or cesspool permitted if public sewer is available within 200 feet.) r p Ta k: Distance from nearest well_________________Distance from foundation-------------------Material --._-___._.___________--__---___.___._-__•___. No, of compartments----- __ __ ___________-Size_____--_------_-_ Liquid depth-- Capacity Distance from nearestr well _ _____ _.Distance from foundation-__ _� __-_.Distance to nearest lot line- TypeNumber of lines-------___ -______-_-`._-_----Length of each line----,� - ---------------Width of trench---- ----------------�--- Z Type of filter material t_ _-Depth of filter material_____Z6---------Total length____________________- - __-__-- Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line__-----__________ ❑ Number .of pits----------------------Lining material---.-------------------Size: Diameter---.------------------- Dept h---------------------_----------- Cesspool: Distance from nearest well------------------Distance from foundation-------------------Lining material__._______..__.____-___---___________- ❑ Size: Diameter------ ------------------------------ Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well----- ____-----Distance from nearest building g----------------------------------- ❑ Distance to nearest,lot line------------------------------------------ ------- -------- -------------- --------- -- ----------------------------------- ------------ 1.11 = l � E Remodeling and/or repairing (describe):_.__ _-_«-__ • 1. -------------•---•---------•-------- - - - � � -} ----- ------------------------------------------------------- ----- •- --- �..._ _,. 4 ti ' I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinance$, laws, and r les and14egulations of the San Joaquin Local Health District. (Signed)-•--------- -- -____-- -- --------- - and/or Contractor) ------ --- ------------ - -- ----- --- ---------- d o a----,-wnerBy:---------------------------- -------- �„" Titleor- ----- -- { ' ) ------------------ ------------ --------- (Plot plan, showing size of lot, location of system in relation to Is, uildings, etc., can be placed on reverse side). FOR DEPA ENT USE ONLY APPLICATION ACCEPTED BY-------•-------------- - ---------- --------------------W•-------------`""T'"- DATE-------•--------- 1 REVIEWED BY-------------------------------------------- ----- DATE------ J ( % ---------------------- BUILDING PERMIT ISSUED-------------------------------- --------------------------------------------------------------- DATE Alterations and/or recommendations----------- ---____-------_ FINAL INSPECTION BY:............ Y ------------------------- 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 8-'59 F.P.Co. f