12356 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) / This Permit Expires 1 Year From Date Issued Date Issued �� bJ Application is hereby made to the San Joaquin Local Health District for a permit to construct. install the work herein described. This application is made in compliance with County Ordi No. 549.' JOB ADDRESS AN CATION.......... ----- -------- - Owner's Name---------- ' •-• .............. Address 5A, -. ------ Phone----------------------••-•---•••--- •-•---•••-----------•--- ----- Contractor's Name____-___._ ------------------- - -- "� -------- Phone-- l A-- d -•-------.-- nstallation will serve: Residence ❑ Apartment House ❑ C mercial ❑ ler Court Motel ❑ Other ❑ Number-of living units: -------- Number of bedrooms -------- Number of baths ........ Lot size --- Wafer Su I Publics stem Communit system Supply: K y' y Y Y ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay [IAdobeAK Hardpan ❑ Previous Application Made: Yes F1NoX New Construction: Yes ElNc� FHA/VA: Yes ❑ No4< TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_________________Distance from foundation-------------------- No. of compartments--------- Material------------------------------------------------- - - - Size--------------------- -------Liquid depth--------------------------Capacity--------•--.--- Disposal Field: Distance from neares ell_- - - __. ..Distance from foundation...... �_�._-,--Distance to nearest 101 line__. T___, Number of lines.________-- f, Length of each line..... ----_-_-- _-- Width of trench- Type of filter material _. __ -s----------------------•-- _--Depth.of filter material___._f _ ---------------.Total length....`'�---------=------------------------ Seepage Pit: Distance to nearest well___________________Distance from foundation_-__ Distance to nearest lot line---------------.- ❑ Number of pits----------------------Lining material'----------------------Size: Diameter-----------------------Depth---- Cesspool: Distance from nearest well-------__________Distance from foundation--------------------Lining material_____-_-_____-_______________:_.___... ❑ Size: Diameter•-------------------------------------Dept h----------------------------------------------------Liquid Capacity--------------•------•-•---.gals. Privy: Distance from nearest well______________________________ Distance from nearest building__________________________________________ ❑ Distance to nearest lot Remodeling and/or repairing (de tribe):____-- -- -------- ----------------- - --- ---- ---..... --------------------------------- - =----= I hereby certify that I have prepared this application and that the work will be done in accordance wit an Joaquin County ordinances, State laws, and rules an regulations of the San Joaqui ocal Health Distric . (Signed) a` �, /I` - �.Q ----- -----------------------(Owner and/or Contractor) --- - - - - By (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can bel placed on reverse side). FOR DEPART ENT USE ONLY REVIEWED BY- -- ---- . ---------- ---- ---------------------------------- DATE---- APPLICATION ACCEPTED BY--__-___-___-____-- ---_- ------------ ------ DATE is r BUILDING PERMIT ISSUED----------- ------ - ---- ------------------------------- ------ DATE---------------------------------------------- Alterations and/or recommendations•---------------------------------- ---- -------------- -- y- --- -:-- -- - --------•------•--•-- ------------------------------ --------- L'- --- - - -- -- ,L--- -- - - -- --.-,t3' --- .- - - --- --------------- ----- --------- ---- ( � `-1 �/3 FINAL WSPECTIOl�? 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 8-'59 F.P.Co.