11234 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. ._ L...__.__,........: (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 compliance pwith.County Ordinance No. 549. JOB ADDRESS AND LOCATION . - PhoneyOwner's Name---------------------------- L --Address------------------------------------------------ --------- d Contractor's j aG Name----- ---------------------•-----------=--•-••----------------------------••------------------------------•--••---------------------._...__-- Phone---•-----------------------•------- Installation will serve: Residence.o Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Ot er ❑ D D d d Number of living units: _�.___ Number of bedrooms___. Number of baths. 'Lot size _______/--------------- ........ Water Supply: Public system ❑ Community system ❑ Private:r& Depth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑,,,,Sandy Loam ❑ Clay Loam ❑ Clay ❑ AclobeX Hardpan ❑ Previous Application Made: Yes ❑ No DK New-Construction: YesR. No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is-available within:200 feet.) J""�-•w Septic Tank: Distance from nearest wel'-'�-r_o------Distance from found ion__:_M---d-_._.__.Materi I__ ______ ______ ______________ ___________ No. of compartments------------------� Liquid depth_.------ -------_ --.Capacity.-----�Q.a__-- Size--- x__��_-- _-- lbisposal Field: Distance from nearest well____ _ __.Distance from foundation---$w_____Distance to nearest lot line____ %.' I w, Number of lines___________________'.._- Length of each line_________---le�_-----Width of trench_____._____ ____ _.__. 2f'�4/� -------- Rs Type of filter material_f'_l-__":Depth of filter material_'__''__8_k___.___Total length____________________T!_-.�___________ Seepage.Pit: Distance to nearest well------------------- from foundation----_----------____.Distance to nearest lot line_________________ ` ❑ Number of ❑ pits----.-___________ ___Lining`materlDiameter Depth___.-__-----------.----------__ Cesspool: Dnearest well--.--_-- ---- � -- ante from foundation ---- Lining ze: Diameter Depth---------------------- -----------------------------Liquid v � Capacity----------•-----------------gals . Cl Privy,,-'' Distance from nearest well Y_i _____-__--_-_____________________ _____Distance from nearestitbuilding------------------------------------------ ❑ Distance to nearest lot line----------------- - --------------------- -- 1-- ------------- �y .. i J 1 t Remodeling and/or repairing (describe) ______._ 1 ` ----------------------------------- --------•------------------------------------------------------------ -• - - -•-•----------•-------------------- ------- - --------------- � � 1 -b certify that l - - - ordinances, State laws, and have prepared this application and that the work will be done in accordance with San Joaquin County i ! here rules and regulations of the San Joaquin Local Health District,. ,:4 (Signed)---- ------------- ----- - f--------------------------------r _---_(Ownener and/or Contractor) BY: #Title)---------i----------- -------=---- --- ------- ------- (Plot plan, showing size of lot, location 6f system in relation to wells,'buildings, etc.. can be placed}on reverse side).it i w FOR DEPARTMENT USE ONLY" s � APPLICATION ACCEPTED BY?----------------�_5----- - ---- ------------------------------{ DATREVIEWED BY ------------ ` ----- DAT C�- - ----- ------ - -A---- ---- BUILDINGPERMIT .ISSUED------I------------------------------------------------------------- f------------------ DATE-------------- --------------------------------------------- Ite ations nd/or r'ecommendations------------------ ------------------ -- -----•�=f----------------•----------•----•------------.---.------------------•---- U _ ----- ----------------- ------ - -•-----------------------=--------- ---- --- ' -- - - - --- ------ ----- ---- -----,-----'�---�-�ic�E'-r„------------- --------- --------- - --- ---- ---� -----------------C---------- � ----------- --- --------------------------------- ---------------------------------------- ---------------------- ------ ----------------------------------------------------------- ------T------ 5 j." ' FINALINSPECTION BY:------------- -------- ----------------------------------------- - Date------------------------------- ...._ SAN JOAQUIN LOCAL HEALTH DISTRICT ' 130 South American Street 300 West Oak Street 132 Sycamore Street $14 North "C" Street f Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 8.'59 F.P.Co.