10618 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate} y Date IssuedApplicationisis 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. JOB ADDRESS AND:LOCATION__.___.-_____--94eo------- ,• �- ----------------- i1 _ y Owner's Name-----_'} ------------------- ------------ - - - - -- ------ - �----- Phone-- _,��.��__ - - - - ----------------------- Address----- -----------•-// Contractor's Name_.-- --_-- -'. � 4 -- -_.....- ! � �--------------------- ---------------------- Phone.--?.(.6s°1 _ ® Installation will serve: ' Residence V Apartment House Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___-L Number of bedrooms 2____ Number of baths -1---- Lot size ---/,t 21__�`'�,,;��----- -- - - --------------- Water Supply: Public}system Community system E] Private Depth to Water Table _ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam I] Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No0( New Construction: Yes ❑ NoFHA/VA: Yes E] No �' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic nk� Distance from nearest well_________________Distance from foundation--------- ----------Material ____-_____-___-_ No. of compartments--------------------------ispos I Size_ Liquid depthC -�- ------- -------------------------- apacity----------------------- Distance from nearest well________________Distance from foundation-----------.--------Distance to nearest lot line_______-_________ Number of lines----------- •----------------------- Length of each line---------------------- --------Width of trench----------------- --------- Type of filter'maferial-------------------------Depth of filter material----------------------- Total length ------------------------------ Seep .�i Distance to nearest weli_.__/-,D-------Distance from foundation--------------------Distanc� to nearest lot of Number of pits------ -�---------"Lining material _C, _---Size: Diameter---,� _�____--_---Depth-. _ Cesspool: Distance from nearest 'Well-----------------Distance from foundation.___--------------Lining material--_____-__--_-.__---___._ Srze: Diameter Depth_'__" - ----------------------------------Liquid Capacity----------------------- ---gals. Privy: Distance from nearest well-----------------k--------------------------------Distance from nearest building ❑ Distance to nearest lot line________________�__ Remodeling and/or repairing (describe):_--__-.-__ ` , gyp - --------- ''� ----------------------- --- •------- r, — ---------------- /� -_---------------- --- - -------------------------- -----------•---------------------------------------------------------------------------------------------- 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 gulations of f Joaquin Local Health District. (Signed)-------- , E r .�� -- ---- �-'�------�--------------------- ------(Owner and/or,Contractor) By: -------(Title)----------- r. (Plat plan, showing size of lot, location o system in.relation to wells, b Ings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------------------ ----------------------------------------------------- DATE --------- REVIEWED BY---•------------ --- 7_D�---- - --------- -- - DATE ------- ------- --------------------------------------------------- ILDING PERMIT ISSUED------------------------------------- ---- -- ----------------------------- --------- DATE---- terations and/or recommendations:_______._ - - ----- ------------------------------------------------------------------ --------- ------------------------------------------------------------------------ ----•-----•-------------------------------------------- ------- -----------------------------------------•------------------------------------ --------------------------------- -- _-- -- - Date__-.:2"_--?- FINAL INSPECTION BY: SAN 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 1-57 F,P,CO.