11612 - Laserfiche WebLink

Home Browse Search

Ir ' / W77- APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) 1 Date Issued __�/ A0 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 Count rdinance No, 549, J08 ADDRESS A5LOCATION_ Owner's Name - -------- Address -----_------ ---------------------------------------- -- ---- v W - - - -- ----------------------- --- } g _. ----- ---- Phone_ 0414 - - - - - -•--- - '- ------- ------------------------------------------- Contractor's Name------------ --------------------- --------------- -------- -------- ------- --- -------------------- --------'_ Phone----•--------- -------------------- ' Installation will serve: Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑, Motel ❑ Other ❑ � of bedrooms __ Number of living units: _1____ Number � Number of baths ___l_.__ Lot size nG__)"a11_�--------------------------------- ft. __ _____ Water Supply: Pubfic system Community system - ---`--- -- Y Y ❑ Private ❑ Depth to Water Table ______. - ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ a Previous Application Made: Yes E] No & New Construction: Yes ❑ Nojgl_ FHA/VA: Yes E❑ No P- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool-permitted if public sewer is available within 200 feet.) . - S�tic T nk:. Distance from nearest well--------I-------Distance from foundation---_._---__•____,-_Material------------------------------------ � No. of compartments---'-------- ------ --= --Size--------------------- --------._Li uid de ah-------------- ------ Capacity- -- --------.. qW_ _P ti { 1 --------------------- ispo lel_:fi Distance from nearest well_.__- _ istance from foundation----_I_�---_____--Distance to nearest lot line__j---_- Number of lines.-_-_---I L_ r Length of each line-----_ ---_ T1 __---Width of trench----- �_-_---_ Type of filter material_ _'-- � Depth of filter material......�_ -----------Total length.__-_- C?-�-_- ' T - - ----------------- Seepage Pit: Distance to nearest well__ __-Distant fr fo fn dation___. Q�-_--_-_.Distan to nearest lot fine--- -__ -•__ Number of its_--._- F P --------------Lining materialK_ _ r Size: Diameter_�{ - Depth---- .------_-- ------------ Cesspool: Distance from nearest well-----------------Distance from'foundation--------------------Lining material---- ? Size: Diameter_ r El -- -------------Depth ---------------------Liquid Capacity----------------------- { --------------------------- Privy: 1 Distance from nearest well___ _ -_ -----------------------------------------Distance from nearest buildin gals. ❑ Distance fo nearest. lot line -__------ g -__ Remodeling and/or repairing (describe)i_____________________ -------- ' -------------------- ---- -- ---- -----------•--------------------------------------- I - -----------------------------------•------ I -- ------------------------------•-----:-•----------------- --'------------------------------------------- I I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County f ordinances. State laws, and rules and regulations of the San Joaquin Local Health District, -� - � `J -----------Z-- ----(Owner and/or Contractor) .. By:------------ --- r' Tale _ ' . --------••------------------------------------ (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---------- A-- -- ---------------------------------- ----- --- REVIEWED BY DATE i� &O----------------------------- - --------------------------------------------------- ----- ---- DATE----1' 1-1-Y------------------------------------------- ----------BUILDING PERMIT ISSUED---------------- ------- ------- ------------ DATE. Alterations and/or recomm ations: ------------------------- -------- - -- ---•--- - ------- --- ------------------------------ - - -- - . - --------------- _- FINAL INSPECTION BY:.-_- - p -------------------------- -v .Date----------------- — - _______ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street Stockton, California I 814 North "C' Street Lodi, California Manteca, California Tracy, California ES-9-2M Revised 1-57 F.P,CO.