11814 - Laserfiche WebLink

Home Browse Search

r Permit No. ...1.1'6�ol-- APPLICATION FOR SANITATION PERMIT „ D (Complete in Duplicate] 3 � do E 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. ,jThis application is made in compliance with County Ordinance No. 549. .708 ADDRESS AND __. LOC TION .--��---- 64 --------------------------------------------•--------------------------•-•------- JOB _- --------- O ' Name •-�•--•--- - - ------------- ----------- ------------------------------------------ Phone------------------------------------ I. Address----------- -------- - ------------------------ ontractor's Name------ ---C-�-�--I----------------------------------------------- ----"------ ------------- Phone-•--•---••---==----•----------•---- CInstallation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ /o a Number of living units: ----L Number of bedrooms __2_._ Number of baths _ -_ Lot size ________________�_.__ _ --_____.___._ ----------------- Water Supply: Public system ❑ Community system ❑ Private [A-tepth to Water Table C6aratter of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [A--Hardpan ❑ Previous Application Made: Yes [:] No %----New Construction: Yes K No E] FHA/VA: Yes E] No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) S�cTof Distance from nearest well-----------------Distance from foundation____.________-.____.Material------------------------------------------------- No. of compartments-------------- --------Size---------------•----------------Liquid depth-------------------------Capacity--------------- ------ Disposal Field: Distance Pram nearest well--* from foundation.____!t.`.a..._.......Distance to nearest lot line_-��._______ . Number of lines.---------1--------- -------------Length of each line___- - - -----_ ----Width of trench. - ---.-------------------- �� -------Total length------------------------------------------ I Type o€ filter material.-- �{f,-_____-Depth of filter material_.f ____`_ c Seepage Pit: Distance to nearest well___r�____-_______Distance from foundation_S ___-.____.Distance to nearest lot line----------------- Number of pits-------t-------- Lining material____ 2 ----Size: Diameter__ K_. ___- -_-_.Depth____..'r_--------------- -------------- ____._ ._ F: Cesspool: Distance from nearest well___-------------Distance from foundation____.___---_..____.Lining materia__.------------.-- ------""als. ❑ Size: Diameter-------------------------------- ---Depth------------------------------------- Liquid Capacity g r Privy: Distance from nearest well-------------------------------------------------Distance from nearest building_________.___--_-______---------------- ❑ Distance to nearest loft line----- --- s - •--------------- ------ ----------------------------------- i Remodelingrepairing describe1' �- Q �1 D � = T�"' ”""" Q �s and/or P { 0A_ WIX-A------ ---------------------------- -------------------------------•-------------------------------------------------------------- -------------------- 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, d ules and regulations of the San Joaquin Local Health District. ------_------------------------{Owner and/or Contractor) (Signed)_ . -------- By:----------------------- ------=----- ---- - Tale (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 APPLICATION ACCEPTED BY''_._.._ __� I-- -- - ---------- -------------------------------------------------------- DATE----- �-' 2 h REVIEWED BY------------- ----- DATE DATE BUILDINGPERMIT ISSOED--------------- ------------- - ----------------------------------------- Alterations and/or recommendations------------------------------------------------------- •-----•-•------• -------"--------------•-""--- --------------------------------------------•----------- -------------------------------------•-- ----------------------------------------------------------------------------- -- -- 2S- � ------------------------------- FINAL INSPECTI 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 i ES-9-2M Revised 8-'59 F.P.Co.