11799 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. _..... (Complete in Duplicate) Date-issued This Permit Ex ices 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a perm;;to cpnstruct in allwork herein described. This application is made in compliance with County Ordinance No. 549. 3 /� JOB ADDRESS AND LOCATION---� `�----- - ------��G' �r ® � j'� -------------- Owner's Name......--- F _`_------ ------ ---------------- .O'f .f12-- _ ..... Address-------- ---------47 ----'8 ^ = == =--=---=---=----------=--------==---------- Contractor's Name------------ _ _ •-------------=----------------------------------------------------------------------------------• -------------- Phone----------------------------------- Installation will serve: Residence [ Apartment House ❑ Commercial-.El. Trailer. Court ❑ Motel 0 Other ❑ Number of living units: __/. Number of bedrooms __ __ Number of baths _/--- Lot size ._ . / � Water Supply: Public system ®" Community system ❑ Private ❑ Depth to Water Table',�'�ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe gF Hardpan ❑ v Previous Application Made: Yes ❑ No ®- New Construction: Yes [}]�-No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: I (No septic tank or cesspool permitted if public sewer i is available within 200 feet.) ! Septic Tank: Distance from nearest well-&-O' Distan e from foundation_"/®Z------Mat rial-_ -------------------------------- ---------- No. of compartments.._7""---------------- .' .._"_Liquid dept! _ _ ---__-__-_Capacity_. . ,a_,02e4 1 !®i �' Disposal Field: Distance from nearest well�'e + Distance fromµfoundation__ _____ _________Distance to nearest lot line-_ __-__. Number of lines----9-,�----------------------------Length of e'µachi fine---/ � -- -------.-.Width of trench---- '----__--_-------------•- Type of filter material be. Depth of filter material---1_t� _--Total length_..-41' �___________________ Seepage Pit: Distance to nearest well_----------------f___Distani e from foundation--------------------Distance to nearest lot line"_-__.__".---_--- S ❑ Number of pits----------------------Lining'material---------- ------------Size: Diameter-----------------...---Depth--------_----------------------:- V' Cesspool: "" Distance from nearest well------------------_:Distance from foundation__`- ---------------Liningmaterial_---.--____"-__-_------------------ ❑ Size: Diameter------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: i Distance from nearest well____"".-_".""""---.."---------------------_-----Distance from nearest building------------------------------------------ ❑ Distance to nearest lot line.-.:-------------l'-------------------------------- -----------= 1 Remodeling .and/or repairing (describe):------- ---------------------------------------•----------------------------- ------------------•----------------------------------•-•------------------- ".-_---__"."__"__.__""""""'____".___--"---__"""_""""_"_"-.-""""_"""__"-""-"-___-.__________________"--__-__----.-_.__----_______"-____"--__.-_-_"_""""-"_""-______""- _--___..__"--______"-.__--_-_-,_____"_--._.-._.__ f ------------------------------------------------------------------•---• •-------------------------------------•---------------------• •---------..----"--------- ----------------------------------------------------- - ----- ---------------------------•---------------------------------- ----------------------•---- -- - - ------- ...... ------- 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, and rules and regulations of the San Joaquin Local Health District. " (Signed) ---- ------- --------------'----------------------------------------------- --------------------.(Owner and/or ontracto B :'-f--•--------------------------------------------- -- - ---------I-------------------------------------------------------------------------------------------------Title (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--------------------- --- - ---- - - -,- ------- ----------------------•-------------------. DATE------- - REVIEWEDBY -------- -- --------------------------------------------------•-------- DATE---- - -�-•----••-----------------------•--•--------- BUILDING PERMIT ISSUED----------------------------------------------- •- --•-------------•-----------------`-------------------------------------- --•---`----------DATE---------- ---•------------- Alterations and/or recommendations-------------------------------------- - ------- --------------------------•--------•---------"----•-_-------- -----------------•--------------------•----------------------- -------------------------------------------------------------'---------------------------------------------------•------------------------------ ---------- -----------------------------------=-=------- --------- ------------------------------------------------------- --------------------------------------------------------•--------------------------------------- ------------ ------------------------------------ FINAL INSPECT -- -- --- _-- Date-.------ _- - ----- _ - SAN JOAQUIN LOCAL HEALTH DISTRICT t 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 a-'59 F.P.Co. '