11798 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued .__ �Zy41,-/� This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct an4 instal the work herein described. This application is made in compliance with County Ordinance No. 544. X71 f JOB ADDRESS AND LOCATION--" ....... ...P -------�.la--_..�----- .4.1 T; - •• ' w _..,- — .- Phona V; _- ---- - --------- Owner's Name--------------- --=---------- - -----------•-••--- --- ----------- Address--------------;;? - 4 � �� --'�-- 5 --------•---•------------------------------------------------------------------ ------•------....__... -� ' Contractor's Name_----:----- -- - --- Phone........ Instaliation will serve: Residence ®' Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living.units:. Number of bedrooms—'? Number of-baths --- Lot size..----- -- -- ---• ------------------- Water Supply: Public system [?J- Community system ❑ Private ❑ Depth to Water Tableat. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe®' Hardpan ❑ r ❑ Previous Application Made: Yes ❑ No � New Construction: Yes {�'Na ❑ FHA/VA: Yes ❑ No 4 TYPE OF INSTALLATION AND SPECIFICATIONS: 1 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) �r��°✓%s�, _. c� - Material------------------------------ --- Septic Tank: Distance from nearest well_ ± __Dir#ante from foundation________. No. of compartments---------- -----------Size_ �- -. -_ Liquid depth--------�-------------Capacity... .a �" - Disposal Field: Distance from nearest weil_�? 't Distancer�m fy�oundation_ -----.Distance to nearest life____ _______. I Number of lines------ --------------------------Length of each line -_ __ � __-�`-----Width oftrenche�---:--- ---- ----------------- rr o- Type of filter material_/f�-q!n'__iDepth of filter material__.1-07--__-_..___Total length_____________J ----------------_---- Seepage Pit: Distance to nearest well----------------------Distance from foundation............-------.Distance to nearest lot line----------------- _ ❑ Number of pits Lining material - --------.Size: Diameter------'-------- -Depth d Cesspool: Distance from nearest well-----------------Distance from foundation-----------_. -..Lining material------------------------------- ❑ Size: Diameter--------------------------------------Depth__._-- --4 --- :---- Liquid Capacity 9 Priv : Distance from nearest well__.________--:t,__._________________-----------Distance from nearest building--------------------- ___„___.__..___.._. Y r ,. ❑ ------------- --------------------------------- ----- Distance to nearest'lot line----------------=-------- - � ---------•-----"-------- '------- ----------------------------- iy __------------------------------_---------------- ___________________________________---------------- _____ Remodeling:and/or repairing {describe�-------------------------------- ----------------------------- x i L -----'-----'----------'---------"-----'-'----'-----'---------- --'------'-'------' - - -•--------•-------- --- :-------- ------ ------ - --- ------ ---- --- --- - I hereby certify that Ihave prepared this application and that the woA wi11 be done in accordance with San Joaquin County ordinance5,-State laws, and rules and regulations of the San Joaquin Local Health District. } - F _______--------(Owner and/ ontractor) -- ---------- _ f --------- ---•---------------------------------------------------- --:---------------------------- [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------- ------•------------------------- -------------------4"1------ --- -------------------------------------- REVIEWEDBY ------------'-------------- DATE------ ---- ------ ---------------•--------------••--.---- BUILDING PERMIT ISSUED------------------------------------ ------------•------------ -- --------- �------------ DATE-- -- --------- -- ------- -- ----------------- -- Alterations and/or recommendations:-------------- ------------- ------------------------------------------=----------••----------------------------- --------------•---------------- ----------------------- A - - -------- -------------- ------ --- - ------ - ------------------- - ---------- -- ------- ----------------------------- -- FINAL INSPECTI --- ---------- ---- Date -------- -------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 914 North "C” Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9— M Revised 8-'59 F.P.Co. -