12952 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: -------------=------------------------------------- ti --_----------------_.-_____-__--.___.-___-____-..: APPLICATION FOR SANITATION PERMIT Permit No. ...1. -•�� _----------------------------------------------------- (Complete in Duplicate) -.--- This Permit Expires 1 Year From Date Issued 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 Ordinanc No. 5499. 1 JOB ADDRESS AND LOC TION. ` {f A Owner's Name---------------------• t1--cA$_ � �1F�� r� � Phone._T�T.. Address r.4 �" .:Ga. `tro ._ 1V�i_.l'�1_!' !X`. _ '.a--•---------------------•----... Contractor's Name....................6_ ------•••-• Phone................._................. Installation will serve: Residence ) Apartment House ❑ Commercial ❑ Tra/il�r Court ❑ Motel ❑ Other ❑ ,� Number of living units: --- rooms of bedrooms I_. Number of baths ._Q� Lot size �.__.9---Q�.r_eS_.__�......._.._ Water Supply: Public system ❑ Community system ❑ Private' Depth to Water Table a...... 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------.------------.) Nolo— New Construction: Yes)k No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if pubyc sewer is available within 200 feet�t- Septic Tank: Distance from nearest we11�j0.AVh DistancQ from foundation..iQ•//4!CIIt.Material..rdw.- A"Ot._.e4W, No. of compartments--___ .. Size_ 4.._x.3~-.-__-Liquid depth_.....---------------Capacity....FP0 101 Disposal Field: Distance from nearest w II5QDistance from foundation-lQ-..&I&A..Distance to nearest lot Lyne_. 1.11• Number of lines--------- -------------------Length of each line_______ _0 Width of trench----_` ,._._.._.. Type of filter materiaMR...Depth of filter material---- $___________-Total length.......--f.$�J..................... Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line..-------_----- 17_1 Number of pits______________________Lining material.....------------------Size: Diameter........................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------------------------------------------ IDDistance to nearest lot line--------------------------------------------- -_-----------------------------------------------------------------------_------•--•-------- Remodeling and/or re airing (descri e):__--___ . -- ------------------••-•-....... �t� •. 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 reg lations of the S Joaquin Local Health District. (Signed) .---------- ------- -----------------------------------------(Owner and/or Contractor) By:-------------------------------------------------- - ------------------------------------------------------------------------------(Title)--------------------------------------- ----- ----------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------------------------- - - ------------------------------•-. ---- --- -------------- DATE------------ REVIEWEDBY---------------------------------------------------------------------------------------- ---- -------------------_---- DATE-------- / . BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE.............----------------------- ------------------- Alterationsand/or recommendations:--------------------------------------------------------------------------------------------------------..................................................... ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•--------------------•-••---•------•••--- -------------------------------------------------------- -•---• -----------------------------------------------•-------------------------------------------------------------------.................................. -------------------------------------------------------- -•--• ..--------------e ---•--• ------ -------- -•...---•--••------------------•--•---•---•-••---••-•----•-- •.----------------------------- ----------------------------------------------------- -------- -------------------- ------ ----••-- ---------•--••-----------•---•---------•---------•-------------------------- -----------------•-•-- FINAL INSP ION BY ------ --- ---- Date------, f .. --------.------------•------------- 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 e•69 F.P.CD.2M 6-60