15402 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: --..- ----- Permit No. ... L ' r � APPLICATION FOR SANITATION PERMIT '•�`. •c ------------------------ ------------- --------------- (Complete in Duplicate) —q , - --_ This Permit Expires 1 Year From Date Issued Date Issued ...................... Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein descrb1;.- This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCI --------------------------------..........--........----....------------ Owner's Name...' R....._. - - •------------------------------•----------------------- ---- -------------------------------------.. Phone......------------------------------ Address.................. -----------------------•--..Address-----------------. ------------------------------------------------------------•-•----------------------------------------------------------•-•----...----•---------------------------•--•- Contractor's Name-------- ._. _.. -------------------------- ----..........I------------------ Phone.-----.....----.................... Installation will serve: Residence Apartment House [j Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ._.___ Number of bedrooms __. Number of baths .1----- Lot size ___+ _________________________________ Water Supply: Public system ❑ Community system ❑ Private elDepth To Water Table -4/o ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 6-`H'ardpan ❑ Previous Application Made: (If yes,date--------------------) No Q' New Construction: Yes E' No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) SeptA;nk: Distance from nearest well-----------------Distance from foundation--------------..'_.Material-----------------------------._--______._-______- No. of compartments------------ - -----------Size--------------------------------Liquid depth---------------------•----Capacity ;..... Dispos , F'r :J Distance from nearest well-100---------Distance from foundatio p r__._._._....Distance to nearest lot linep........ ❑ Number of lines------I---------------------------Length of each line___;_`.-____._..._.._.Width of french-+4.�°__-__________-____----_ Type of filter maferiag- I p4A----_-.__Depth of filter material_'/1K________________Total length------�97 r Seepage Pit: Distance to nearest well---Lao-_r .- _________Distance from foundation. 0-------------Distance to nearest to lin�.��.f ___._ �+�1 � [� Number of pits..._1-__-.___-_----Lining material__J?t GCA-----.--Size: Diameter__-_�_�-`--------Depth---- Cesspool: Distance from nearest well-________________Distance from foundation--------------------Lining material--------------------................. Size: Diameter--------------------------------------De th---------------------.-.---------------------------_Liquid Capacity gals. i Privy: Distance from nearest well ______________----------------------------------Distance from nearest building________________________-_.____.-.-.-----. ❑ Distance to nearest lot line--------------------------------------------- ------------------------------------------------------------------------------------------------ Remodeling and/or repairing (describe):--------- -----------------------------------------------•-•-------................................... ------•-•--------------------------------------. , k ----------•------••----•-----•--------------------------•----------------•----------- ------------------•-----------------------------------•---------•-----•---•--•------------•------------------------------------------- ---------------------- ------------------•---•--- ----------------------------•--------------------•-------------...-------------------------------------------------------------------------------------------------- I hereby certify that I have prepareLis plication and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and of the San Joaquin Local Health District. (Signed)---------------------------------------------------- --- -- ---------------------------------------------- -----------------------------------------(Owner and/or Contractor] sr---------- ------ - - - ---------•----------•--------------------------.._.. trifle) - (Plot plan, showing size of lot, to n of system in relation to wells, buildings, etc., can be placed on reverse side). �I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -----•---------••----------- DATE —� t REVIEWEDBY------------------------------------------- -- ---------------------- -----. DATE-------------.-----....-------.._...------------------_.... BUILDINGPERMIT ISSUED------------------- --------------------------------------—---------------------------------•---- DATE------------------------------ Alteratio s and/or recommend'ati ns------- --------------------- --------- --------• ----••-• 1 _ - - -- -.--•- - - ------—-- �kr •--------� ------------••----------------------------------- ------------------------------------------------------ ---------------------------------------------------------------------------------- ------------------------ -------- -----------• --•---••-•--------------------------------------------- ................. --------------------------------------------------------------------------------------------- ---------------------------------- FINAL INSPECTION BY:----. .a...- . _a ------ Date------- -- -�`�-------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Strut 300 West Oak Street 124 Sycamore Street 20i West 9th Street Stockton,California Lodi,Cal lfornjar Manteca,California Tracy,California ES 9 REVISED 8-59 2M 5-62 ATLAS