12382 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. �.... (Complete in Duplicate) 4-2- 1 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 5,49 f r " JOB ADDRESS AND LOCATION y° " �: _'i :_ . --- =xt Q Owner s Name -- ------- - i - -- --�e--- -------- Phone_.... Address _> .••-------------------------------- �� , Contractor's Name-------------------------------------- ..---- Phone..-------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __ts__ Number of bedrooms _' _:_ Number of baths _/___-__ Lot size _,; _1('--_ - -1 --------•--------------- Water Supply: Public system 05 ' community system ❑ Private ❑ Depth to Nater Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ _Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yo New Construction: YesNo E] FHA/VA: Yes E] No E] 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_--"_ztl__Distance, from foun ion__1P__ ateriaL__- ------ ----- • No. of compartments____._�,___----___._Size__- -----Liquid de th__.__.__�"_ ---- -------- Capacity---- --------- wl Disposal Field: Distance from nearest well--- ''___-....Distance from foundation--!° _�"'Distance to nearest lot line____ _�^ Number of lines.--------- .-e-;Length of each �� ____Width of trench_--_2_`�__.'___-....__.._.__ Type of filter materiaL___.___� __ E3epth of filter material_____/_1'_'�_____Total length___.____._ Q. _.____.______.__. Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------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------------------------------------------------- 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 la and rules and regulations of the San Joaquin-Local Health District. (Signed)---- •-------- ----- ------- --- 01,`.`=--------------------------------------------- ------------------------------------(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). F0R'6 PARTM[ENT USE ONLY APPLICATION ACCEPTED BY- '� a .. .•.. i' _ , --------- -- DATE J -- -- - ------ REVIEWEDBY------ A-- ----- ----- - --------- - --- -------------------------- DATE .= r - �' ` '---------------- ----- BUILDINGPERMIT ISSUED--------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- _...� ' - . - - (', %-.fit ^ .t .fin,------ Alterations and/or recommendations:_ i� --- -` ........... _------..:' _ - '�- a-----` � = ------------- ---- ' -- ' .f_ --------------�'-- -".---=----�-' -'k"------ T- - -`--._'�--'--:: --------- ---------- __ y -`-------------------- -----'----------------------------------------- --••------------•--- ----• -------------------------------------- ----- - ---- -------- ------- --- --- ----- ----------------- ------ --- - - -------------- --------------------------•---- -------------------------------- -------- FINAL INSP B • -- - ----_�-Q--- - Date. -1 `� 2 � ---------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 8-'59 f.P.Co.