9030 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. .-- (Complete in Duplicate) 7,[ yy. _ Date Issued .--•l' --- Application is hereby made to kto the San'Joaquin Local Health District for a permit to construct and install the worrein described. This,applicatiori is.made in compliance_with County Ordinan e No. 549. k2/L/-/er_S cf JOB ADDRESS A LO ATIO --------- r -----------:-------�*'------ - ------ Owner's Name------- ----------1 --------------•-------------------------- - - -------------- - ------------------- Phone--------------------------------•--- Address------a. --g-+----F -- Installation will serve: !Resid Phone.: Contractor's Name---------------- (4 Residence '( Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other E❑ Number.of living units: Number�� rr1 of bedrooms _ . Number of.baths j---- Lot size ---- -------••---••--------------•---•-------------------- :_ -:.-- Water Supoly: Publics stem Community system i PPY� Y I ❑ Y Y ❑ Private Depth to Water Table __ -"ft. Character of soil to a"epthlof 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay'Loam M Clay ❑ Adobe Hardpan❑ Previous Application Made:,Yes ❑ NoNew Construction: YesF�No.❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic +ank`or'cesspool permitted if public sewer is available within 200 feet.)• " Spr eptic Tank: Distancefrom nearesr.wail-- Distarice from four ation_ ._ Mat ri 1=_ �• '________• No. of compartments------- . ------ Size--- _ _ --Liquid depth Capacity_. _ a Dis osal Field: Distanceifrom nearest well.. - _ __ Distance from foundati p Distance to nearest to line __-.- Ndmberl,of lines__.--�--------_--..--_.----- Length of each line-_-_- --_.a- - ----:Width of trenchtz___--•.------ --------------- r Type of'fi4er material_.5'_r_�epth of filter material-----� _--__---Total length--------f_�__jZ_6----- ,_- Seepage Pit: Distance�to nearest well_.__ "____��_-�_-_Distance from foundation-_-_----..-.' nearest lot line___ _____________ 0 ❑ Number:.of pits----------------------Lining material --------------------...Size: Diameter-----------------------.Depth-------------•------------------- N :p _ _ Cesspool: Distance l`from nearesf well _-.----_Distance from foundation--------------------Lining material--.-----_-_---._-_---.------.__.__- r ❑ Size: Diameter----------------'----------------------Depth----------------------------------------------------Liquid Capacity--- ------.-----.gals. c Privy: Distant i from nearest yell- ------------777777 ,- .- - ----------------Distance from nearest building------------------------------------------ ❑ Distance fo-nearest-lot line.__ _________ _ __ - — Remodeling and/or repairinc {describe):__ - ------ -. - '►• =------- -- -- ------------------------------------------------------------------------------------------- -------- ----------------------------------------f I: R: - ------------ -------------r .------ ------m - •-------_--=----- •---•�----------•---•--------------------•-------------------------------------------------------•-- ----------------------- I hereby certify that I have prepared this application and that the work will be done1n accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. ----- ($i ned) ' � -------------------------------- -----------------(Owner and/or Contractor) By: I------------------- ---------------=------- ------------------------------------------------------(Title)---------------------------------------------- ----•------------ (Plot.plan, showing•size of-lot, location"of•sysfern in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY I , • APPLICATION ACCEPTED BY----- ------ A. ---------- ---------•-•--- DATE........•--------------- -- REVIEWEDBY-------------------- - --------------------•------------- DATE BUILDING PERMIT ISSUED--L------------------------------------------ ------------- DATE ------------- -------V-1------------------ Alterations and/or recommendations------------------- - --- ------------ - - ---------t!---a- --------•-•-•--------------------•-- ----- - ------------..... ------------------ 4 1- ---- ,. ----3 ------------------ ----- - ---- - --------------------- - --- ' ---------=-------------•------ ------------ ............. - FINAL INSPECTION BY = = = - Date - ---#7_------- ,� = 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 1-57 F,.P.CO. i