15935 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: -------------------- Ap _/1_ --------& --____.._._.__.______/.......--------_-.___--------- APPLICATION FOR SANITATION PERMIT Permit No. , --------------------------------------------------- (Complete in Duplicate)- (� -------Expires 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 Ordirpnce No. 549. ZIR.. JOB ADDRESS AND LOCATION -------- - -- A___....._.. Owners Name ........ ....._._.. --------=--------- Phone----------......................... Owner's - t ------------------------------------••---------•-•----------- .. Contractor's Name '/ -- - -------------------- -•• ------ Phone.._. •------•-•...--------•---• Installation will serve: Residence [lj-`Xpartment House ❑ Comrhercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ._`_. Number.of bedrooms,.._: Number of baths/..... Lot size _ ,1 „�.............................. Water Supply: Public system ❑ Community system gge�Isrlvate ❑ Depth ro Water Table ft. Character of soil to a depth of 3 feet': Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date-----------_________) No 'New Construction: Yes g?0'_No ❑ FHA/VA: Yes �"No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) or Septic Tank: Distance from nearest well------ from foundation--- Q________.Material___�c__� ...................... No. of compartments.-_.:._____.___.______Size_ `r '�___Liquid depth___ ��` Capacity_. ._.___- Disposal Field: Distance from nearest well...... ---____Distance from foundation---�,�!------Distance to nearest lot lines._/_..... ®� Number of lines-------- .. _ .. _ _ Length of each line___. r�! Width of trench____..�.1....................... Type of filter material._.l�/�Gt% Depth of filter material__ r _ '�_______-Total length__/e� ------------_______________ Seepage Pit: Distance to nearest well-----:-- --------Distance f m fo dafion---fA9......:..Distance to nearest lot line................. �} Number of pits___ -___-_-------Lining material___ _ _ Size: Diameter'___...___Depth_ --__________________ Cesspool: Distance from nearest well________________Distance from foundation------------.------.Lining material---------------._-_____-____-_--_-_-- ❑ Size: Diameter. -----------------------------------Depth---------::----------------------------------------_Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------_:---. ❑ Distance to nearest lot line--------------------- .. -- -----•-----•------•-----------------------------•----------------------------------- l a-- -- _-- r Remodeling and/or repairing (describe):------------ ----- -- -------------------------------------------------- --------------------------------------------------------------•---=........_-. -•------------- d --------------•----------------------------------------•----•-------------• -------------------------------------------------------------------------------------------------------------------------------•-- I hereby certify that I have prepared this applicafion and that the work will be done in accordance with San Joaquin County ordinances, State laws, a d rules and regulations of the San Joaquin Local Health District. (St d -9ne )-•-----••-------• ----r------- - - ---- --------------------- --- ----------------------------- r Contractor) B .--....--•---------•-------------------I---------- - Title..... (Plot plan, showing size of lot, location of system relation to wells, buildings, etc., can be placed on reverse side). FOR DEPART USE ONLY APPLICATION ACCEPTED BYV-_,) ----------------------------------- DATE-_X.0_ •.cam ---------•---- REVIEWED BY------------------------•--•--------_ ---- l = ----------•--------------------------- DATE--=- BUILDING PERMIT ISSUED -T Alterations and/or recommendations:._ ...... ._.___ �a_ �__ _ - -- - - ----------•- -•-•------ -------------- - ----------------------------••---•--------•----•---•------ --•-----•----•----••----•-----------------•----•--------•---••- - --• •-------------------- ---------•--------•--------------------- ------ ------------ --.. -.... k FINAL INSPECTION B . ------ Q.-- -- --- -- Date „s �-- /'�-------------------•------- SAN JO UIN LO AL HEALTH DISTRICT ! f� 130 South American Street 300 West Oak Saeet 134 Sycamore Sir**" 205 Wast 9th Street Stockton,California Lodi,California Manteca,California Tracy,California . r ES 9 REVISED 8-59 2M 5-62 ATLAS r