10823 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) 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. C51 ----A--. JOB ADDRESS AND L ?1,117 ...... ,6:�ON__ -,-- - -- ---- -------- ------------------_---------- __X-4, Owner's Name-------_ ,---- -------------------------------------------------------------------------- Phone.; Address----------------------- -, ---------------------------- --- ---------1------------ ---4� J_zrn v-0704 Contractor's Name ve-- ]� -vr--------------------- P Installation will serve: Residence Apartment House Commercial El Trailer Court E] Motel E] Other E] fi. Number of living units: ___1_ Number of bedrooms __�_'__�. Number of baths __/__ Lot size /-2-s------------------- Water Supply: Public system 1AKCom' munity system--El' Private F ] Depth to Water Table eft. Character of soil to a depth of 3 feet: Sand El Adobe 04ardpan C ��Gravel E] Sandy Loam E] Clay Loam F1 Clay E] -1 Previous Application Made: Yes E] No w Construction: Yes El No FHA/VA: Yes E-1 No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Distance from neatest.well-----------------Distance from foundation-------------------Material-------------------------------------------------- No. of compartments-----`----------k-----------Size--------------------------------Liquid depth----------- --------------Capacity...-------------------- � D offal i�ld: Distance -------------Capacity_-------------------- Disfance from nearest well_:___._.'Disf9nce from4oundafion------------------- Distance to nearest lot line-___._-_._-.____. 'Number of lines--------------------------------' Length of each line----------------------------.Width of trench----------------------------------- Type rench----------------------------------- Type of filter material__-_______________________Depth of filter material_-_.-___-_____-_ -----Total length:_______;------------------------------ Seepage Pit: Distance to nearest welt _"r'Distance fror;-f6uridatio I� 7----.Distance to nearest l6t line----- -- Number of pits----11---------------Lining material -,Size: D ia mete r__ D e pth Cesspool: Distance from nearest well__--______--____Distance from foundation------------------- Lining material__.__._-----___.___.___-_____.--_-___. F] Size: Diameter--------------------------- -----------Depth------------------------w--- - --------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well--------------------------------------------------Distance from nearest building__--_.-._______--_-__--.-_.--_-__--_-`._. ❑ Distance uilding-------------------------------------- Distance to nearest lotline _-__�7�- - +-- -------------------------------------------------------------------------------------- - ---------------------------------------- Remodeling and/or repairing (describ e):-- -- -------- --------------------------------------- -------------------------------------------------------------------------------- - v--------------------------- -- ---------------- -----------------------------------------------------------------------------------------------------------------------------r--------------------------------- -------------------------------------------------------------- - --------------------------------------i-------------------------------11---------------------------------------------------------------------------------------------------------------------------- ----------------------- - I hereby certify that I-have prepared this application and that the work will 6e done in accordance with San Joaquin County y ordinances, State laws, and rules anc+ regulations of the San Joaquin Local Health District. I--) .Y j _T m.(Signed)---- pnC-Tj\ -------------------- Contractor) ---------------------------------------------------------------- BY:__ -------1-ft ---- - ---- - -- (Title) (Plot plan, showing size of lot, location of system in relation to wells, build#gs, etc., be placed on reverse side). FOR DEPARTMENT US 6 ONLY JC,) ----------------- APPLICATION ACCEPTED BY-- RA --------------------------------------------•------------------------------------------------------------------ DATE------- .. ........ REVIEWEDBY---------------------------------- ------------------------------------------------------------------------------------------ DATE------ ---------------- ------ -------- BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------------------------11---------------------------------- Alterations and/or acommendafions:-------------------------- ----- -------------------------------- ------------------------------------------------------------------------ _17---------- ------------- --------------------------------- ------------------- --------------------- ------------------------------------------------------------------------------- --------------------------- ----------- --- --------------------------------ot_v----------F-!-"---q--(—---------------------------------- ------- -------------------------------------------------------- ------------------ ---- ------- ------ ----------------------------------------------------------------------------------------- -------- ------- ------------------------------------------------------------------- --- ---------------------- -------- ------------------------------------ ------- ------- ---------------- �411 FINAL INSPECTIO BY: ----=-- --------------- ------------------------------------- W V\------ Date--- ,SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lod,, California Manteca, California Tracy, California ES-9-2M Revised 1.57 F,P.CO.