19965 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE; APPLICATION FOR SANITATION PERMIT Permit No. -- - ----------------------------------------------- ----------------- ---------------- --------- (Complete in Duplicate) ----------- -------------- This Permit Expires 1 Year From Date Issued 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 application is made in compliance with County Ordinance No. 549. C.,e j,5N77q -C7— - JOB ADDRESS AND LOCAT N__ � � �--�-- �- ----------------- Phone. ------------• Owner's Name------ ------- - --- --- - -- -sC--------- -------------------- ---------------------------- ------------ - ---------- Phone..._.. AddressF-'`+i/-- � -- ------ --- �ar.r ------------- ---- -- - -----•--•------------------------- •-----------------------------------••-•-------------------------------- Contractor's Name.------- - ------ - - . --------------- ------ ------------------------------------------------------------- Phone----------------------------------- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel Other ❑ Number of living units: -__ .___ Number of bedrooms __' . Number of baths -f Lot size -------------- Water Supply: Public system Community system ❑ Private Depth to Water Table /i 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 [&0"'New Construction: Yes ❑ 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--------------------Material______..-______.__._____________...____..._.___- /��stt''� No. of compartments--------------------------Size----------------------------:---Liquid depth---- -------------- ----Capacity----------------------- Disposal Field! Distance from nearest well_ � --_Distance from foundation-_ �_ _ Distance to nearest lot line_____ L s�Number of lines-------�r�-___ Length of each line__/AW- Width of trench,___---_ Type of filter material .fy / _Depth of filter maferial__/�___.-----_Total length___.Zee__________________________ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line--.__________._ C ❑ Number of pits----------------------Lining material-_---------------------Size: Diameter.----------------------Depth-------------------------------- C Cesspool: Distance from nearest well-----------------Distance from foundation-------------------.Lining material------------------------------------- El Size: Diameter------------- --------------- -----.Depth-------------------------------------- ---- ------..Liquid Capacity----------------------------gals. Privy: Distance from nearest ---------- Distance from nearest building ----------------------------- ---------- y ❑ 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)--------------------- v i"� c' ----------- -- ------------------ (9 /or Contractor) Title ,-�-. (Plot plan, showing size of lot, location of system in re n to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY--------------------- --------------------------------------------------------------------------- DATE-------------------------- REVIEWED ---- ---- REVIEWEDBY-------------------------------- - ----- -------------------------------- --------------- . ------ DATE BUILDINGPERMIT ISSUED------------------ ------------------------------------------------------------- -- : 1- - - Alterations'and/or recommendations:-------------------- - -- - ------------------------------ -- - -- ----------------.----------------------- ----------•------------- -------------------------•------------- ------- -------------------------------- ---------------------- -------------•---------------- -------------------------------------------------- -•------- ------------------ ---------- -------------------- --------- ----------------- ------------ ----------------- ------------ ------------------ --------------------------------------------------------------•-- -------------------------------------------- ------ - -------------------------------------------- ----------------------- --- ------------------------------------ -- l FINAL INSPECTION BY- -----------� — � Date------/� SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street' 205 West 9th Street Stockton,California Lodi, California Mantecar California Tracy,California F.P.CC.