16532 - Laserfiche WebLink

Home Browse Search

FOROFFICE USE: ---- ---------------- APPLICATION FOR SANITATION PERMIT Permit No. ._� ------------------A ---- (Complete in Duplicate) o "/ L.10� --.--- 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. JOB ADDRESS ANDCATION -•--........................ ...,........ _.. ---- -------- ------ - --•-•-•--------- Owner's Name. -------- --------- ---- Phone................... __ Address............. . --------. . ��) �� ............•................................................................................... ContractorsName . ............................................................................ Phone....................................... Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: : /__ Number of bedrooms -A�& Number of baths ./.._ Lot size .__....... ...._.....��' Water Supply: Public system'T Community system ❑ Private M-**Depth to Water Table .'�__�t. Character of soil to a depth of 3 feet: Sand ❑ Graver❑ Sandy Loam ❑ Clay Loam [''Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date------------- } No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No Jg— TYPE OE INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted-if public sewer is available within 200 feet.) Se 'c Tank: j Distance from nearest well Distance from foundation- ---------------.Material------------------------------------------------- No. -___---___---- _---_-------_-_._-__-_-_.No. of compartments------------- ---------Size---------------- ------------Liquid depth..........................Capacity--. Disposal Fielo: Distance from nearest well-----------------Distance from foundation: ",t, .......Distance to nearest lot line ..... f�F Number of lines....................... .......Length of each line................_.._.........Width of trench... .......... ......._...az: Type of filter material---------_--------------Depth of filter material..........._.----------Total length....................................3ft. ppi Seepage P•it: Distance to nearest well-----,'q----------Distance fro fou ation_._ . ..__._ ..._.D t n e to nearest lot line """.'_... Number of pits-----/___-____-__Lining material..._ .I.€e. Size: Diameter._ �_...:_Depth-4_0__�_______________ Cesspoo. 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---------------------------------- ----------------;r.......... ------•--•--------•. =-- ---.-•-.. ----•----------- 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)................ ................. (i Contractor) By ........................ (rile) ; ---- ------ (Plot plan, showing size of lot, location of system in tion to wells, buildings, etc., can be placed on reverse,,side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY•-- -------------------------------•-----------•---------------- DATE.. /.... 63----- .--- .--------------------- REVIEWEDBY.............................................................................................................................. DATE._..-------•----------- BUILDINGPERMIT ISSUED........................................................ — .................................... DATE.-- •-•-•--- ........................................ Alterations and/or recommendations:--- •--•----•--------- •-• ••.. -- •-----•---._.:... .-------•-•--• --- -------•--------••----------------••-•----------. ---•--•-•--••-------•------------ ------------------ --•--------------•----------------------------•---'-------------------------------------------------------------------------------•--------------------•------------------ FINAL INSPECTION BY:. - --------------------------------- Date---A-Zz ................................................. SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E$.9 REVISED S-59 3M 3-'63 F.P.CD.