14367 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: T ..----..___« .--_ __.. �` `.__._;� APPLICATION FOR SANITATION PERMIT O Permit No. .,1�.��......../.... --------------------------------------------------------- (Complete in Duplicate) , 1p Date Issued ... --------------------------------------------.-..---------- This Permit Expires 1 Year From Date Issued V{ .. .�._ 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. 54 ��s ,� ' JOB ADDRESS A LOC ON_.. .......4.e Name.---- �.. . . ----------------•-•-.....-------•-•-------•....------------------------------------------_. Phone.................................... Address................. = ---------- -•-••-----•----.-----•------------- ------------ ------------------------------------•----- Contractor's Name.............. -• -----•-•-••----------------------------•••----------------•-------••-------•-- =.Phone.---.............................-- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑/Motel ❑ Other ❑ Number of living units: __/•_- Number of bedrooms .,;:?_. Number of baths __Z_ Lot size ..Q�. �4W............................. Water Supply: Public system iKcommunity system rivate ❑ Depth to Water Table '1115�!ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date____________________) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Spp� Tank: t Distance from nearest welL................bistance from foundation....................Material.__ •---------•......... ..... ...... f No. of compartments--------------------------Size--------------------------------Liquid depth..........................Capacity.........=......-....... Disposal-Field: Distance from nearest well-----------------Distance from foundation....................Distance to nearest lot line................. Ak,.106*7 Number of lines-----------------------------------Length of each line------------------------------Width of trench------- .--------------------------- / Type of filter material_____________________-.-Depth of filter material-----------------------Total length...._................................... Seepage it: Distance to nearest well___"��'___..Distance m f nclation_.. .._...D' t f� to nearest t I j9e..N�i_._�..._ Number of pits...... ............Lining material ---Size: Diameter.. g.__ _ ,Dept h 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):------------------------- -......... .....--........................................................... .........................................................•...----•-----------•--------•-----•-•-------------------------------------------------------------•------•--•-----•------------...-----•----•-------•-•--••-------- 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 t e San Joaquin Local Health District. (Signed). 9 ) c�I�/ 4 ----------------- ------------------------- -- --------------•------------------ �r Contractor) By:...................... --•••(rifle) ------ (Plot plan, showing size of lot, location of system in relation ells, buildings, etc., can be placed on reverse side). FOR DE RTMENT USE ONLY APPLICATION ACCEPTED BY---'- ! - ------ DATE------••---•-------•-•----------.....--------••-•......••-- BUILDINGPERMIT ISSUED---•------------------------•---------------------------••-----...................................... DATE............................................................. Alterations and/or rgcommendations•----------------------- - /p.-/-.__-- - --_--- -- --_--------- ----------------- K� �.. -. .1.')_---""__L�`za�i.-.:�.�,i:::_.____ .. ____.(!6__{�L. {�L,�2 .-_.,�._. ___f__.__ ... .................................... ------ FINAL INSPECTION BY.--_I---- /�X -�`� Date. �5 -- --_I=—, ...................................... SAN ------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street '205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 5-59 YM 6-61 ATLAS