13573 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. ../.;_5 (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 isTmade.in compliance with County Ordinance No. 549. iL� . JOB ADDRESS AND LOCATION-- ------- -------------------------_-- Owner's Name " --------. Phone-------------------------•---------- Address------------ -fF ------------------------------ � C Contractor's Name------ -- - ----i10------------------------------------------------------------------------------------------------------------------- Phone.------------------•------------•-- Installation will serve: Residence ❑ Apartment House ❑_Commercial ❑ Trailer Court ❑ Motel Z Other C]Number of living units: _ir___--- Number of bedrooms _i_� Number of baths _Z__ Lot size ----- __ _______ __4_ _------------------------ ----- Water Supply: Public system ❑ Community system ❑ Private D( Depth to Water Table 164__ 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 ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No epti tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank' istance from nearest well-----------------Distance from foundation--------------------Material-_.________________________________._____------ No. of compartments--------------------------Size--------------------------------Liquid depth--------------------------Capacity----------------------- Disposal Field: Distance from nearest well...'70-____._Distance from foundation_A.�__.._______-Distance to nearest lot line___-__'k'--- 1. ; Len th of each line----1--167'4---------------Width of trench--- - -�!------------------ - y Number of lines---------]-__ ------------ -{- g - o Type of filter material Depth of filter material_-_II-''_______._Total length____I__'r''4_____________________________ O 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---------------------------__-______. 0 Size: Diameter----- -------------------------------Depth----------------------------- ----------------------Liquid Capacity.....-----------------------gals, . Privy:. _Distance from nearest well-----.------------------------------------------- from nearest building----------------------------------------- � ❑ Distance to nearest lot line------------------------------------------------------------------------------------------------------------------------------------------- Remodelingand/or repairing (describe):---------------------------- ---- --------------------------------•----------------------------- ----------------- -•------------------------- --------- --•-----------------------•------------ --------------------------------------•----------------------------------------------------------I---------------------------------------------------------------I-------------------- ------------------- -• ----- ------------ ------ --------- --------------------------------------------- •---------- --------•----------------- ---------------------------- -- �1 I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sta laws, and rules and reons ofi the Sa Joaquin Local Health District. I Si ned - ----------------------------------------------- -------(Owner and/or Contractor) By:------------------- --- ------- ------------------- ------------------------------- ---------------------------------------------(Title)----------------- - ------------------------------- I (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be•placed on reverse side). FOR DEPARTMENT USE ONLY 19 APPLICATIONACCEPTED BY --------------------------------------------------------------- DATE__ '. _: --------------------------------- REVIEWEDBY---------------------------- ------------------ ------------------------ ---------------------------- DATE BUILDINGPERMIT ISSUED----------------__---------------------------------------•---------------------------------------- DATE--------------------------------------------- --------------- Alterationsand/or recommendations-----------------------------i------------------ ----------• --------------------------------•-----•---------------------•--------------------------------------- ____________________________________________.___--_-__._______-_-___.____......--_-__.__.______-__..____-_.______.__._-_________.--___.-___--____.__.---..______-___.___-___________ _____________________________________________________________________________________________________________________________________________________________________________ ___---------------------------_-------------------_-----------------------------------------------------------_------------_____------------------------------------------------------ FINAL INSPECTION BY: Date.... �. - l f! ----------- ----------------------------- SAN INSPECTION BYA� 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 6-'59 F.P.Co.