10208 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No_ ______________ ________ ' (Complete in Duplicate) /(? k- 11�1 �D - _ Date Issued ------ -----_J Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This applicatiori is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION__ _____ — -s--- ----- ------------ - --------- - d- Owner's Name------------------------------ ------_) _Y _es------------------------------ -----------------------------------.-. Phone--H-d.... Address----------------------------------------------------- e------'=---------'- `----------------------------------------------------------------- ! Contractor's Name------_,Z---�--- -�-_ )_----------------- Phone----•---------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __/____ Number of bedrooms_3__ Number of baths-_1----- Lot size ---Y7__K_7_Y---------------------------- _____ Water Supply: Public system ©- Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑f Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 2-"Hardpan ❑ Previous Application Made: Yes [] No New Construction: Yes ff'�No ❑ FHA/VA: Yes ❑ No []� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) 1/ / i } _ Septic Tank: aDistance from nearest well___��-_--------Distance from foundation___ __3t____-__.___.Mater�al___-_�dhC�`C. _______________________. [ No. of compartments______" --!_----- Size---�S .Y�._..____.Liquid depth--------`Y --------Capacity---[-n---------- Disposal Field: Distance from nearest we!I�P__-------_Distance from foundation---_1 '_._______Distance to nearest lotline_______. Number of lines_____--_-��-a..+:_,- Length of each line____---- --------_.Width of trench____,�_Y��_Z-___; Type oFfilter materi ___1W __._` -Depth'of filter'material___'1_ _______________To#al length ______ _ 5eepa Pit: Distance to nearest well_______________ _____Distan Tom- aton__! _____._= Distan�e to nearest lot line___________ Number of pits-------- A_ Lin ing mater 1'-' --- - ize: Diameter-_--.- " __ _-_._Depth____ : ________________ 6 Cesspool: Distance from nearest well-----------------Dista oundafidr-_------_--____--._.Lining material________.---_________-____________- ❑ Size: Diameter---------------------________.--------De th_--_____--_____ .-Liquid Capacity P �- q ----------------------------gals. Privy: Distance from nearest well--------------------------_--------_-------------Distance from nearest building______________-__________.______________- ❑ Distance to nearest lot lire--------------==---------- --------------------------- -----------------------------------------------------------•-------------------- 9 Remodeling and/or repairing (describe):-------- ---------------------------- ---------------------------- ----------------------- -------------------------------•------------------------------------•------------------- - -----------------------------------------------------------------=----------------------------------•--------------------------------------------------------------------------------------------------------------------- %n --------------------------------------=-----------------=---------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certif haf'I have prepared this application and that the workWill'be' done it accordance with San Joaquin County ordinances, a s, d r Wgulaff, ns of the San Joaquin Local Health District. f (Signed)--- -------------- -----------------------------------------------------------------(Owner and/or Contractor) I , = ------------------------------ ------ -----------------------------------------------------------------------------(Title) (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). r FOR DEPARTMENT USE-ONLY APPLICATION ACCEPTED BY r-�f --'-t.-------..-rv------------------------------------ DATE------1a lS_ .s..5-6-------------------- REVIEWEDBY----------- I------------------- ---------- ------------------------------------------------------------------------------- DATE------------------------------------- ---------------------- BUILDINGPERMIT ISSUED-------------------------------------- --------------------------_- -- •-------------------- DATE------------------------=---------------------------------•- A �. _ _! , ommendat4io_-ns------1------�- ` a 'n ----- --- . ----` �. -- - ---------------------------------- ------ �-- _ r � ----------------------------------------------------- ---------------------------------------0---------------------------- ---------- ------------------ ------------ -----------------------------------------------------------------------------------=-' - -------------------------------------------------------------- ------ ----------------------------------------------------------------- ------ -------------------------------------------------------------------------- FINAL INSPECTION BY:----- �. ! ----- Date !.f- ! ��.s SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street $14 North "C" Street Stockton, California Lodi, California y ,�artecc, California Tracy, California ES--9-2M , Revised 1-57 FY CQ-