12529 - Laserfiche WebLink

Home Browse Search

147 APPLICATION FOR SANITATION PERMIT Permit No. ..Z�L5... y (Complete in Duplicate) Date Issued --- /;42;, 011 his Permit Expires 1 Year From Date Issued C � Application is hereby made to the San Joaquin Local Health District for a permit to construct and install a wor here�inadoescry3ib*'"(ed19&4). This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND TION______________ - f-------- ._ Owners Name Y ---------------------. Phone 'S .......... -------------- Address.____-__•-_- Contractor's Name------- ----------------------------------------------------------- Phonv'31 Installation will serve: Residence g Apartment House El Commercial E] Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___ ___ mber of bedrooms_. Number of baths _/_/ Lot size __.__ �� - -------------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table _W- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe&-1H*"ardpan ❑ Previous Application Made: Yes ❑ No [ New Construction: Yes ❑ No ((, FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: *Noseptic tank or cesspool permitted if public sewer is available within 200 feet.) Distance from nearest well_________________Distance from foundation--------------------Material------._-____--__--_-..______.______..___._.___.. No. of compartments_-----------------------Size--------------------------------Liquid depth---------- ---------------Capacity----------------------- d ®Id: Distance from nearest well_________________Distance from foundation_-...__--__-_---___.Distance to nearest lot line--_------------ Number of lines-----------------------------------Length of each line------------------------------Width of french__-__-_._____---.__._____._._____,_ Type of filter material__ ______W Depth of filter material____-_-_____-_-____Total length____-__--_--•_____________ UNSeepage Pit: Distance to nearest�`'ell Distanc fo dation_ .._._.Distance to nearest lot line_�s____.__ IDNumber of pits__--_/__________-__Laterial- Size: Diameter__,3.3__ Depth__�S________________ 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 1 Remodeling and/or repairing (describe)------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ .- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------•------------------------------------------------------------------ I hereby c tify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, S t laws, and s and r gulati of the San Joaquin Local Health District. (Signed) Liter ----- i� - -Owner and/or Contractor) By:----------------------- ------------- - -- - - ---- --- ------------------------------------------(Title)- --- .--------------------- - - --------- ---- (Plot plan, showing size of lot, to ation of system in r tion to wells, buildings, etc., can be placed on reverse side). FOR DEPART ENT USE ONLY APPLICATION ACCEPTED BY___.______________________ DATE___.___ - - --------------- --------------------------------------- ------ ------------- --------- --- REVIEWED BY-------------------------- DATE ----------------------------------------- ----_---------------- -------- -BUILDING PERMIT ISSUED - ------ DATE. -- ----------------------- Alterations and/or recommendations:------------------------------------------- ----------------------- -----------•-_____--.----___-__,- ----------------------------------------------------------------------------------- ------- �t----`-='----------- `a' ' - '� - �j --------------------------------- ------------------------------------------------------------------------------ --------------_----------- ----- - ----- ----------------------- -------- FINAL INSPECTION BY: - C`a Date ) --- _3-C-j - 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-92M Revised 8-'59 F.P.Co.