12581 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: r �✓ --------------------- APPLICATION FOR SANITATION PERMIT Permit No..% --------------------- ------ --------------------- --------------------- (Complete _ _ _ -_ Com lete in Duplicate)%�" "1Date Issued ..... ............. ________________________________________ 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 ma!Za in compliance with Coun!tLY Ordinance No. 54 9• JOB ADDRESS AND LOCATION ........ ........................... Owner's Name/ ------ ---- ._ Phone --_------ �'"��c Address-- �—_U_1/--- --- _ -- -- --- .------•----------=--- .............. ........................ -•-••--•------•- Contractor's Name ......... `c... -__ -- --------- ._ ----- --r�...... Phone_ Installation will serve: Residence .j�j Apart nt House ❑ Commercial ❑ Trailer Court ❑ Motel Other ❑ Number of living units: __/.. Number of bedrooms _Z --- Number of baths __/..__ Lot size._�x,/.w-` ----_-_---•------------- Water Supply: Public system M Community system ❑ Private ❑ Depth to Water Table 4 t. 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)R!f New Construction: Yes/10 No ❑ FHA/VA: Yes ❑ Noj;�' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest Distance from foundation.,%%ll..�__-___. e ial_________ rrzF? ....._... �fNo. of compartments ------ _Z.-_-----__-. Size -_-141. ��____... Liquid de,,t t,...._____________ Capacity....., .. Disposal Field: Distance from nearest well__-=--. ? `Distance from foundatio �®. istance to nearest lot line ..___�r.- ._.... Number of lines ........ l--____ ----___ __ Length of each line -------------- ______________Width of trench -___Z................ __._ .__ Type of filter material _ __ __ Depth of filter material_ /X ___.. _Total length ___--_--____iii r ..... Seepage Pit: Distance to nearest well :�-''.._._Distance from fo dation Distance to nearest lot line.... ___... Number of pits -------- f ----------- Lining material. _ _-___Size: Di eter___ ........ _... Depth-: Cesspool: ' Distance from nearest well _________________Distance from foundation -------------------- Lining material ...................................... ❑ Size: Diameter---- --------------------------------- Depth ---------------------------------------------------- Liquid Capacity ............................ gals. Privy: El Distance from nearest well ------------------------------------------------- Distance from nearest building .................... ................... Distanceto nearest lot line----------------------------------------------------.A------------------------------------------------- ------------------------- - ----------I Remodeling and/or repairing I hereby certify that I have prepared this applic tion and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rul s a regula ' ns o e San oaquin Local Health District. (Signed)-- -----=/------- -------------------------- ---(Owner /or Contractor) -----------------------------... --............................. (Title)-• ------------------ (Plot pla size of ocation of system in relation to wells, buildings, etc., can be placed on reverse- ee). FORS. DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- ------ -........ ----------------------------------------- DATE---- REVIEWEDBY--------------------------------------------------------------------------------------------- ---•.......................... DATE ............................. BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE ............... .............. Alterations and/or recommendations: ----------------------------- ________________ ------------------------ ----- - --- ..--- ------------- ---- /as�6c1 ------------------------------------------------------------------------------------- ------------------------ FINAL INSPECTION BY- ------ ------ ------------------------- - -------------- --------------------•------------------------------------------------ ...................................................... C� Date. - ------------------------------•------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street Stockton, California Lodi, California Manteca, California E0.9 REVISED 0.59 F.P.CD. 2M 6.60 -------------•--_.._. 205 West 9th Street Tracy, California