12558 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. ..1_a S __ __ (Complete in Duplicate)_ -r Date Issued -----�4A R This Permit Expires-1 YearFrom Date-lssued, 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 with County Ordinance No. 549. JOS ADDRESS AND LOCATION---------- - --- - -- ---- p t 4 Phone--- =-&7=f-r,---A--- --- ------ Owner's Name--------- „A ----------- ---- Address----------------A__L5�--•3--•w4 ------ =- -------------------------------------------------=-----------------------------------F : .... Contractor's Name--------------------------------=------------------------------------------------------------------------------------------------------------ Phone----- ---------------- 1 Installation will serve: Residence ❑impartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -�;--- Number of bedrooms _7Z.- Number of baths _-L..-- Lot size ----7--6- 4- ---------------------------- Water Supply: Public system '0. Community system rivate ❑-,Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe &�Hardpan ❑ Previous Application Made: Yes ❑ No ©,—New Construction: Yes [2o ❑ FHA/VA: Yes ❑ No [� TYPE OF INSTALLATION AND SPEC IFICATIOkSc - (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septiq Tank: Distance from nearest well --___---Distance.from'.foundation_---!-�-__--_--.Material-__-11,✓,�/--4_.�1- -- ------------- [� No. of compartments------_----X----------Size------CJ1_i1.__,?_X_-4------Liquid depth------ - ----------Capacity------ ------------- earest IField: Distance from.nearest well......' ----_`D•. f fVation--.. o�_s_Distance to nearest lot line- ��-_--- �L fi '[ Width of french------Number of lines---.._-__ dg h 6f eaah. _ Type of filter material__0stc - -___-_Depth of filter material----.1- ----------Total length__----- a--__-.-_-------__--_.-- Seepage Pit: Distance to nearest well.............' --Distance from foundation---. -_-_-_-_.Distance to nearest lot line---S`---. Depth ❑ Number of pits------- .-.------- Lining material--------------'---------Size: Diameter----------------------- --------- r t Cesspool: Distance from nearest well------Lr�--------Distance from foundation-----------. ------Lining material------------------------------------- GLi Capacity ----_gals. ❑ Size: Diameter---- --------------- ---------------Depth----• -- -----'--------------------------------------- quid CP Y- ---------------- - 9 '1 Privy: Distance from nearest well-±'_.,__:----___ ------Distance from nearest build••sng----------------------------------------- ❑ Distance to nearest lot line--------------------------- - -' Remodeling and/or repairing (describe:------------- ------------- --- --------------------------------------------------•---------------- i ---------------------------------- ------------------------ ------------------------------------------------------------- ----------------------------------- ( -------------------------------------------- ---------------------------------- ----------------------------------------------------------------•--------------------•-;--•----------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the wbrk will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Ir Local Health District. (Signed) '"`”"`�` �` --------- --------------------•------------------------ ----------------(Owner.and/or Contractor) 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 � = ------------------- ----- - REVIEWED BY------------------------- ------ . DATE-------I-- ---- -- ------ ----------------------------------- - PERMIT ISSUED------------------- DATE-------- ------- ------------•- I Alterations and/or recommendations:---- - ---------- ------------------------------------------------•---------------------•-------------------•--------------------------------------- ------------------------------------------------------------------------------------- ----------------------------------------------------------------- ------------------- --------------------------------- t ------------------------------------------------------------------ ------------------- -------•-----------------------------------. FINAL INSPECTION BY:-__..C.'--__-.;� ... -- ------------ - ---- .. ------- Date-- --- ------------------- ----------------------------- �AN 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 S-'59 F.P.Co.