10539 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. .�a 1k, (Complete in Duplicate) Z Date Issued 1 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. JOB ADDRESS AND LOCATION__.._ t ----------------------------- Owner's Name-------- 1it ------------------------------------------------------------- ------ -------------------------------- Phone---------------•---__--•------•- Address---------1,,6..;*......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 __/._ Lot size ---�Q__,.1�_ _,�,Q_______________________-___ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table -419 It. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 0_.19ardpan ❑ Previous Application Made: Yes ❑ No [�r New Construction: Yes ❑ No [L?0"FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) 4eptif�Tank: Distance from nearest well_________________Distance from foundation-___-_-_-.•________.Material______--.____-_-__-___--_-•-_--.-___._______-_--.No. of compartments--------------------------Size-----------_------------------Liquid depth------•-------------------Capacity--_----------------- r Dis sal Field- Distance from nearest well___'._____--_Distance from foundatior��.�`_-_--___Distance to nearest lo/tt�lli`e_.jJ___._... Number of lines-------- ________ Length of each line______ __ .........Width of trench----A7.'__ Type of filter material__4 .Depth of filter material----�4?'-----._Total length--------�„ �'?------------- --- ,,4�eag�P't: Distance to nearest well-___-_"_______Distance fr}�pm-� fo�undation_....$ 4--•--.Distapce to nearest lot line___Number of pits Lining materiaL_.� -----Size: Diameter •1�, Depth Distance from nearest well-----------------Distance from foundation---.----------.____.Lining material------------------------- ❑ Size: Diameter------------------ -------------------Depth-------------------------------- -------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well------------------------------------------------- from nearest building.__:__-________-____._____-_--__-___._. ❑ Distance to nearest lot line---------------------------- - Ny Remodeling and/or repairing (describe)-------------------------a& ----------------------------------•------------------------------------------------------------------------•--------------------------•------------------=---------------------------------------------------------------•- --------------------------------------------------------------•-----•------------------------------------------------------------------------------------------------------------------------•-------•------------------------ 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)------------------�----- - -- - --- ------- - ------- --•-- ---------------------•------------------------------•-•-------------(A or Contractor) By:---------------•----------------------------------- - ---------O, `-------------------------------------(Title)------------ ?%W_ ---------------------------- (Plot plan, showing size of lot, location of tem in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------------------------- -- -- ---------------------------------------------------------- DATE------------- 1 REVIEWED BY--------------------------------------------- ------ -- DATE 1 BUILDINGPERMIT ISSUED---------------------------------- --------------------------------------------------------- DATE-- -------- ------ -------------------- Alterationsand/or recommendations-------------------------------- -----------------------------------------------------------------------------•----------------------------------------------- --------------------------------------------------------------------------------------------------------------------- ---- -----------------------------------------------------------------•------------------------- ---------------------------------•----------------------------------.-------------------------•---------------------------------------------- -----------------------------------------------------•-------------------•--- ------------------------------------------------------------------------------------------------------------------•------------------------------------------------------------------ _----------------------- --------- -------------------------------------------------------------------------------------------------------•-------------- ------ --------- FINAL INSPECTION BY:---------- " Date----------- ----- ------------- 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,CO.