11264 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No.'.___.�1__2 6__._ /� — (Complete in Duplicate) �, �\ Date Issued _ ____- r� _` 4 _ ' S Application is hereby de to the San Joaquin Local Health District for a permit to construct and install the work herein described. ThisW is m in mpliance with County Ordinance No. 549. JOBS A LOCATI _. _ ..r ---u7_- . - Owner's Name--------- ---•-•----------------------------------------------------------------------- Phone------------------------------------ Address �r�s ' r ----- --- Contractor's Name----------------------- f L/--------------------------------------------------------------------- Phone----------------------------------- Installation will serve: Residence [er'"Apartment House ❑ ,Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __/__ Number of bedrooms%9-. Number of baths .-O�-_- Lot size ._ 6�_�?�_-__/ '_-__-__-__-____._ Water Supply: Public system ❑ Community system ®-*Frivate ❑ Depth to Water Table*Kr`'ift. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No 'New Construction: Yes W4--No ❑ FHA/VA: Yes [4—No ❑ 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---- ^----Distance from foundation---- -Material.__ No. of compartments-----A-_-----_--.-- izes0 /0--- -_-Liquid depth---- _„ ' Ca aui t_y_ _/'a� Disposal Field: Distance from nearest well------ ---------Distance from foundation../"�........Distance to nearest lot line_otow_`... Number of lines----------- __ Length of each line----- _ ___.___ Width of trench_____ </ - --- ---------- Type of filter materiaLy A ,X Depth-of filter material_ . _-._.Total length____,,r� Q___________________.. Seepage Pit: Distance to nearest well. ��__-.___Distance fr m foundation__ �7�".Distance to nearest lot line—/Oi ®/ Number of pits___4o-2i-_ ------Lining material___ .4?4/e-Size: Diameter__&*3.........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)---------- -------� . --- }---.4 ----- ----- I --------------------------------------- -- ---------------------------------------------•-------------•---•------•-----------••--------------=------------------------------=------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -----------------------------------------------------------------------------•------------------------------- ----------.-----------•-----------------------.---------------.------------------------------------------------ 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)9 ) -- ------------------------------------------------------------------K6===CVQr Contractor). By:------------ --------------------------- --- ------ (Title)------ (Plot plan, showing size of lot, location of sy m in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------�i_P_�Q.-___________._________.____ -------------------------------------- DATE------ - ! REVIEWEDBY--------------------------------------------..------------------- ----------------------------------------------------------- DATE----------------- BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------- Alterations and/or recommendations_______ ______ ________________ ____ ._ i --------- ---- -------------------------------- .--(- A ------------------------------------------------------•-----------.-------------------- ----------------------------------------- ------------------••-----------------------------------------------------•••----------------- ------------------------------ --------------------------------------------------- r FINAL INSPE N Date------ 7 ` f 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 1-57 F.P.GO.