9487 - Laserfiche WebLink

Home Browse Search

s:. 'APPLICATION .FOR SANITATION PERMIT Permit I�?o. 1 � (Complete in Duplicate)� �Date Issued __.�l__7�s=, _T 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 Ordin ce N 549. ADDRE�ESSS`AND,LATION--_-___y._�_!__P�.---- ----- ---------------------- ------------------------------------------------------------ JOB Owner's Name------------------------------- - Phone .. Address--------- ---- Contractor's Name_______________ k---- ---------(--_- - --- -- -- -- -----------------•-----•---.... -------•-----: ------ Installation will serve: Residence X.rApartment House F].-Commercial ❑- Trailer fCourt, El Motel ❑ Other ElNumber of living units -/'__ Number of bedrooms __c�2_ Number of baths __/. Lot size ._-- ----------------------__-_ Water Supply: ' Public system Community system.[-]. Private ❑ Depth to Water Tabled`ffi" Character of soil-to a depth 6f.3 feet:< Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam E] Clay ❑ Adobe' Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes ❑ No X FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS:4 (No septic tank or"cesspool permitted if publi se er is available within 200 feet.) , Septic ink: Distance from nearest we€!�-_. istance �j'g°m foLPdation___AQ— __--_.Material-_--.__-•_-- ----------------------------- No. of compartments__�__C,_Z---_------------Size_.. __-Liquid de th_____ _y_ Capacity----f40-------_ I �_�1._...__.Distance to nearest lot lin -------- Number �_-- pisposal field: Distance from nearest�.well�QDistance fr m foundation__ ,i Number of lines_______________________ __ Length of each line_____•S_____.________ Width of trench______. Type of filter maferral r_ _ Depth of o er m eria1_---.-A..__....{Total length___._-_.�d--------------------------- Seepage Pit: Distance to nearest well`&y_�wS ___Ca cla :on---_��_____Distance to nearest lot line_________________ [ Number of pits------�-------------Lining m ___ Si e. Diameter_---J�-�� ... Depth-----Q-&'_____________-.__. V Cesspool: Distance from nearresf,well----�!--�___:_-_ u at ion--------------------Lining material------------------------------------- p`\ .Size: Diameter_--__'_-±--_s_ - ---_- -.'------ Deth_-- ------ - 3 .---Liquid Capacity ----gals. IIVV Priv Distance from nearest-well:---__ €----------------- s Distance Pram nearest building Y r 1 - -- ----.- -- T g--------------------------- ---------- ❑ Distance to nearest-Iot'line_---------__ - --=----- ------ ----------------------•-•-••-------------------------------------------------------------------------- Remodelingand/or repairing fdescribe) ------------------------------------------------------------------------------------------------•------------------------------------------------------ ------------------------------------------------------------------- \ Y -------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, +e laws, an ules and r gula+ions f +he'San;laequin-Local Health District. v. (Signed)---- = (J -- ---- -------- -- ----:---------------------------- ---- Owner and/or Contractor) , By:------------------------------------ fJ C/L� _____•---••-•----------------•----(Ti+le) ------------------------------------------- (Plot plan, showing size of lot, location of system in re! tono wells; buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY f APPLICATION ACCEPTED BY----------------- I DATE-----___ _ REVIEWED BY----------------------------- ----- = ------ ----------- DATE.__. L� ------------------------ BUILDING PERMIT ISSUED-----•-------- - ----------- -------------------------------------------------------------------- DATE------------------------------------------------------------- Alt rations and/or recomm fl tionsi-_ i-_- _____ __ ------------------- iA t1 Q..` �' ---- ---------- '' -- ---- -------------------------------- ------....------ ---------------------------- --------------------------------•-----•----------------'-----=--------------------------------------------------------------- --------------------------------------------------------_- " i' DFINAL INSPECTION-BY "- --- -- '-""-�----4- - -- ----- -------- ate-==-- ZU• - ------------------------------------- •----------- SAN -•------.SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 014 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-7-2M Revised 1-57 F,P,CO.