12381 - Laserfiche WebLink

Home Browse Search

9�,/,z,1,6 6 V___ D!30 APPLICATION FOR SANITATION PERMIT Permit No. _2_23.YY (Complete in Duplicate) Date Issued 9 � 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 application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND OCA�TIO .. V--------------------------- •-------------------------------------------------- -, Phone...Owner s Name--- ......... ------------------------------------ Address ---------------- ------ Address--------------_- ---------- ----- - ------------•-•----------------------•--------------------------------------------------------..._...---------------------------------- Phone............................. ------ Contractor's Name_.-- / Installation will serve: Residence [!f Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms ._�Z_ Number of baths __ _ Lot size -----'?. 'Qf-----------------------••------- Water Supply: Public system ❑ Community system ❑ Private E!�7epth to Water Table -4-6_ ft. Character of soil to a depth of 3 feet: Sand F] Gravel E] Sandy Loam El Clay Loam ❑ Clay [-1Adobe2] Hardpan C]Previous Application Made: Yes ❑ No A- New Construction: Yes p No ❑ FHA/VA: Yes ❑ No p-- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool Permitted if public sewer is available within 200 feet.) Septiclank: Distance from nearest well-----------------Distance from foundation--------------------Material------------------.-.----____________._-_______- ❑ No. of compartment-s-------------- -----------Size----- --------------------------Liquid depth--------------------------Capacity----------------------- Disposal Field: Distance from nearest well ................Distance from foundation--------------------Distance to nearest lot line._______________. ❑ 0 Number of lines-----------------------------------Length of each line----------.----------------.--Width of trench----_------------------------------ Type of filter material------------------ Depth of filter material-----------------r----- otal length-----------.------------------------� Seepage Pit: Distance to nearest well_/& _r-------Distan��ceroom� f undation___-0-____.-_.Distance to nearest lot line__.�a____---- Number of pits.-.----'-------------Lining material____Jl `E�-----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------ ---------------------------------------------------------------------------------------------------------------------------------- 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 re la ns of-the-San-Joaquin Local Health District. (Signed)-------------------------------------- ----- ------- -- --- ------ -------------------------------------------------------------------------- -------(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 APPLICATIONACCEPTED BY--------------------------------- ----- - ----------- ---------------------------------------- DATE-------------------------- --------------------------------- REVIEWEDBY---- ------------------•-------------------- ----------------- -- --- - - - ------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED-------------------------------------------- — -------------------------.---- DATE------------------------------------------------------------- Alterationsand/or recommendations:-------------- - ----- -- ------------------------------------------------------------------------------------------------------------•------------------- ---- - ------ ----�'-'-`------ `� ----- ------------- ---- ------------------------- --------------- -.._. FINAL INSPECTION BY:----- --6031 ----- ------ Date qi -A ? - � SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Sfraet Soo West Oak Street 132 Sycamore Street $14 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Rcvlsed 8-'59 F.P.Co.