11921 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. .___.___ (Complete in Duplicate) Date issued fi.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�y�r SQtr6lty'Ordinanc o. 549. JOB_ADDRESS AND LOCATIO __ ----- - - ---------- ---- -- --------•--------------------•----------------------------------------------------------- Owner's Name-- ----- � •------------------ ---------------------------------- ----------- Phone-------------------------------- Owner's y- --------------+•------_- -------------------- ------ --- --- - -------------------------------------- ----------- Contractor's Name Phone--------•------------------------- ----- Installation will serve: Residence U;e Apa ment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑II Other ❑ Number of living units: -__I_._ ber of bedrooms ___ -_ Number of baths _ ____ Lot size .__r __sX-A- - -------------------------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table_ft, k Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [B--Hardpan-❑ Previous Application Made: Yes 0 No ❑' New Construction: Yes ❑ No [�R- FHA/VA: Yes ❑ No E5-� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_!.!----Distance from foundation---1_Q...r_.___.Materia� _ No. of compartments_____ y _Size__ _ y,�.+ Li uid de th-__---- ___ Ca acit ' 1..__ Disposal Field: Distance from nearest well--- --------Distance from foundatlon:__1Q___-__.___Distance to nearest lot lineA--___________. Number of lines----:--.-------------------------Length of each line------------------- 7--------Width of trench-------Z_ _ L7 J,..._ Type of filter material___'T I.4------Depth of filter material____ ----________Total length------ ---$_(-1 ir- Seepage Pit: - at+em =-------------Distance to nearest lot line___ K Number of pits--- -- - - i�rc��4&1__ 0 ------ - ----- ------ a -------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation-------------------.Lining material-------------------------------------- El __-_____-____.-----_.________ .-__. # Depth---------------------------------------------------Liquid Capacity----------------------------gals. Size: Diameter--------------------------------------- Privy❑:. Distance from nearest well______-____------------------------------------Distance from nearest building--___.-._________-_________---------:---- ❑ " Distance to nearest lot line--------------------------------------- -------------------------------------•--------------------------------------------------------- Remodeling and/or repairing (describe)------------------------------------------------------ •-----------•-------------------------•--•----•--------------•------------------------------------ -------------------------------------------- ------•---------•-------- -------------------------- ------------------------------------------------------------------------------------------------------------------------------------- - - -- - --------- - ----------------------•--------------------------------------------------------------------------------------------------- I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State law;;�w ations of the San Joaquin Local Health District. (Signed)----------------------- -- --------- ------- ------------------- ----------------------------------------- -------(Owner and/or Contractor) By:---------------------•--------------- • =• - Title -- - -=------------------------------------- ---- ------------ -- - - ----- ----------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR D PARTMENT USE ONLY APPLICATION ACCEPTED BY/. `' -- REVIEWEDBY--------------------------- --- --- ------------------------------------ DATE--- ------------------------------------•------------------- BUILDINGPERMIT ISSUED--------------------------------------------------------------- - - - ------------- ---------------- DATE------------------------------------------------------------- Alteration nd/or recommendatio :______ --- -------- ----------- ----------- ------------ ------------------------------ -------- ----- FINAL INSPECTION BY:. ------------ Date------ ---- q__ 1 SAN JOAQUIN LOCAL,HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Sfock+on, California Lodi, California Manteca, California Tracy, California ES-9-2M Rev ed 8-'59 FT Co.