14354 - Laserfiche WebLink

Home Browse Search

FOR OFFICE SE: _______._____. - ----------- ---_(____.._ .; ? APPLICATION FOR SANITATION PERMIT Permit No. . ..a' .. --------------------------------------------------------- (Complete in Duplicate) �6 Date Issued ..�" 1t_ - -------------------------------------------------------- This Permit Expires 1 Year From 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 O inance No. 549. JOB ADDRESS AND LOCATION - 1 = ............................................-.................. Owner's Name.___ _. _- Phone...................... Address............................... Contractor's Name.......... ... ... Phone................ Installation will serve: Residence ®—Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Ar ..► Number of living units: 1..?__. Number of bedrooms _ _ Number of baths Lot size ..... ...AYO.......................... Water Supply: Public system [Community system ❑ Private ❑ Depth to Water Table 6P_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe�Hardpen❑ Previous Application Made: (If yes,date____________________) No e New Construction: Yes a?"No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r 4 r Material-- -•_______ ________________ S�*ptic .ank: Distance from nearest welh.��h►!�sDistance from foundation/9............. . ........_.' No. of compartments.-_3-____-__t......Size._..'�''4..9ngKf Liquid depth____41__________________Capacity...- ..........qA IF Disposal Field: Distance from nearest well Distance from foundation_ .............Distance to nearest lot line--- [ _� Number of lines.......................___---------Length of each line......._......................Width of trench........... �f.`.......... Type of filter materiarTAl"r..........Depth of filter material-----f$''__......Total length......14042.......................... Seepage Pit: Distance to nearest wgyjp�-..._---_---_-_Distance-figm foundationO_f....--..•...Distance to nearest lot line..tr'_..l...... [' -Number of pits......__---_�-,___ ___Lining material-----_ 0------Size: Diameter..�$1.1-11.___-__..,Depth----....Ar.............. ❑ P ---------------------------------------------------.Lining material------------------------------------- Cesspool: Distance Diameter nearest well------ ---------De Distance ce from foundation_ _ -- - • '•• 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 t is app ation an that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and reg tions the Sa Joaquin Local Health District. (Signed).........-................. .... .... •-- -- ----------.......................------------------------------------------(Owner and/or Contractor) By:.....-................... . ............ ...... ----------- ----- --------...........................................(riitle)-------------------------------------------------------------- (Plot plan, showing size of lot, ion of system in rely ion to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -------- DATE--L>s.` �,1� " L................... REVIEWEDBY-------------------------------------------y------------------------------------------------------------------------- DATE........................................................... BUILDINGPERMIT ISSUED..............................................................-...................................... DATE........................................................... AJt atign�red/or rec mmendations: - --------- ---------------------------------------------------------------------------..-------..._.--------.--------._--._---__.___-_-__-.____..-•--..-_-_-----•-----_.-.-._-____..____------_--____-----_-__-_---_-_-_-••--__.._.--.__- -- _----------------------- FINAL INSPECTION BY:----- _ .._�._. -� ^• �--- Date__.._._ _____ 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 2M 5-61 ATLAS