15928 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: y --------------------------------- _____________________ APPLICATION FOR SANITATION PERMIT Permit No. ----------------- ------ - (Complete in Duplicate) _ , Date Issued __`r __V -------------------------------------------'-------.- --. This Permit-Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This�ya�pyplication is made in_ �compliance with County Ordinance No. 549. 0SO—Z6 ajeq `-�J JOB ADDRESS AND L CATION--- ------------ --- ------A_. a _.-.----- f yy� Owner's Name f'� ''f { --•----------------------- ------ ----- - ----------------- -------- Phone-tf�-._....---------------------- Address------------------ r-------------------------------------------------•--------------- --------------------- Contractor's Name--- � ----------------------------------------------------------------------------------------------------------------------- Phone----------------------------------- Installation will serve: Residence R] Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number.of living units: J__- Number of bedrooms._ Number of baths __f--- Lot size ------------------------------------------------- r . Water Supply: Public system ❑.; Community system ❑ Private [E Depth to Water Table _ rft. Character of soil to a depth of 3 feet: Sand ❑ Gravel .❑ Sandy Loam ❑ -Clay Loam ❑ Clay PJ Adobe ❑ Hardpan4y Previous Application Made: [If yes,date.-----.- ) No Q New Construction: Yes R1 No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank'or cesspool permitted if public sewer is available within 200 feet.) - Septic Tank: Distance from nearest well_ ____Distance from foundation____ Q_.____ _.Material___ ----- -------------_--- - � ]] - No. of compartments---_- ^..___._____..____Size_Y_&_!__V-r_X-------- Liquid depth----- ________---------Capacity_1,;-_9�R------ Disposal Field: Distance from nearest well„rq--------Distance'from --_ .Distance to nearest lot line___47I Vv (� Number of.tines______._-_____ Length of each line----.{�___ ________ Width of trench._,A_ f{-------------------- 1 Type.of,filter materialj � _--Depth of filter material-_____ -rn_____.-Total length____ _ __________________________ Seepage Pit: Distance to nearest well—- -----------------Distance from foundation--- to nearest lot line-.�7r_____._ 099 ;. ,, r- Number of pits---- -------------Lining material-- __._-- --------Size: Diameter----,-2_�..__-__.-.--Depth_--r't�..____..__.__._._-- Cesspool: Distance.from nearest well-----------------Distance from foundation--------------------Lining material-..-.-.-__-_--_---------.----__-_-_-_. El Size: Diameter--------------------------------------De th----•-- --------------------------------------------Liquid Capacity ---------gals, Privy: _,Distance.from nearest well_________________________________________-.---._Distance from nearest builcling------------------------------------------ ❑ Distance to nearest lot line-- --- --- ------ ----------------------------------------------------------- --=-----=---- -----------------------------------`---------- Remodeling and/or repairing (describe):--------- -----------.----------- --------------------- ----------------------------:-------------------------------------------------------- =-----------------------------------------------------------------------------------------------------------------------------------•------------------------------------------------------------------------------- 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)....... -----------11-:-----=---- `�- ----- --------------------------------------- ------------------------------- ---------(Owner and/or Contractor) By: ----------------(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-_ __ ,. 1 ” _____________ ,G -------------------- ------- - DATE-- - -- ---G� _ REVIEWEDBY-----------------------------------------'---------------------------------------------------------------------------------- DATE---------------------------------------------------------- BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------------ - ---------------------------- Alterations and/or recommendations--- ------------- -- --------------------------------------------------------------------------------------- -------------------------- ---------- --------------------------------------------- --------------------------------------------------------------------=--------------------------------------------------------------------------------•--------------------- ----------------- ------------------ --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- - ------------------------------- ------------------------------------------------------------------------ - ----------------- ------------- --- --- - -------- -------------------------------------------- ----- FINAL INSPECTION Date SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California ES 4 REvtsEo 8.59 3M 3-'63 r.P.CC. .ti. w..��• 1i