11561 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued __rr 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. 544 JOB ADDRESS AND LOCATION_______ ----{--/ ----- f Owner's Name-------� �---------•-- — - ---------------------------------------------------------------------- ---- ---------------- Phone Address---------------- a r l?� -- --------------- -----------•----------------------------•--------------------------------•--- --------- ----------- _ -------- _ - t - Phone. _ Contractors Name-------------.-- ----- - �S _ Installation will serve: Residence Apartment House ❑ Commercial E] ' Trailer Court E] Motel E] Other P _G-. Number of living units: ____ Number of bedrooms _1__ Number of baths _-l---- Lot size --_,--`��--�_- OO------- ----------------- Water Supply: Public syste ?f3�feef: Community system ❑ Private El Depth to Water Table eUft. Character of soil to a depth Sand E] Gravel E] Sandy Loam E] Clay Loam ❑ Clay E] Adobe Hardpan F] Previous Application Made: Yes ❑ No ❑ New Construction':--Yes E� No FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) ypoc�,!,, Jnr ( Distance from nearest well-________________Distance from foundation--------------------Material---------------.________________----.---_____- Sr� No. of compartments--------------------------Size--------------------------------Liquid depth---------------- ---------Capacity----------------1--- ield�� Distance from nearest well- --- ---_Distance from foundation ----------- to nearest lot lira_______ o , Number of lines______ ,]� Length of each line______ _____ Width of trench_ _�i�_---__- N If------ Type of filter material ___ _______Depth of filter material Se length_-- ""----- ----- Se e Pit: Distance to nearest well_-_�_-________Distance om fo ndation____��__._____.Distar)ce to nearest lot line_____.___ Number of pits______ _____________Lining material---�� ---Size: diameter___ --- Depth 1 C sspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- El Size: Diameter-------------------------- -----------Depth------------------;--------------------------------Liquid Capacity---------------------- ----gals. Privy: Distance from nearest weft--- --------------------------------------------Distance from nearest building-------_______________________----__-__-_. [] Distance to nearest lot line--------------------------------------------------------------------------------------- ---------- j-------------.-- Remodeling and repairing (describe):____.`. -- -- - + ------ ;+� ------- ---- --- -- ---------------------------------------------------------- ----------- ------ - ---- ��-- * /rte/-- - -- - --- -------------------------=----------------------------------------------------•---------------------------------------------------------------- I hereby certify that I have prepared th' cation and that the work will be done in accordance with San Joaquin County ordinances, State laws, rules and reg tions o the San Joaquin Local Health District. Owner and/or Contractor (Signed)------------------------4)� -------- By:------------------•------------------------------------------------------------ -- -- --- - (Title)------ r --------- - - --- - ------ (Plot plan, showing size of lot, location of system in relation to wells, bu + .gs, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------------------- - - DATE---------l �-�' � ---- REVIEWEDBY--------------------------------------------- ---------W----------------------------------------------------------------- DATE------------•-------------------------�------------------ BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------ DATE Alterationsand/or recommenda�-ions:------ - - ------------------------ ------------------------------------------------------------------•--------------•---------------------------- ------ Z -------�� ---- 'FA l------ �` -_------- ------------------ ---------------------------------- ---------------------------------------------------------------------- ------ -- ---- ------------------------------------------------------------------------------------------------------------------------ ------ ---- = ---------------- FINAL INSPEC�I --- --- ------ ---- Date----------/�� -�` SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Steelton, California Lodi, California Manteca, California Tracy, California ES-4-2M Revised 1-57 F-P.CO.