14255 - Laserfiche WebLink

Home Browse Search

FOR OFFICE US --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. __. `. :............ (Complete in Duplicate) ------.-.--_ This Permit Expires 1 Year From Date Issued Date Issued ..�5.. .� 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 Ordina 9 No. 54 .�C� 474 JOS ADDRESS AND LOCATION.------------------------------------_--.------ ................---------- - --------------------------------------------- Owner' - -- Owner's Name---._ '.�. ----••--- Phone------------------------------------ --•--- -------•--- Address........... -Address---•--..._. .. a ^' . Contractor's Name--__-_--� -_- ".'...._- ......................•---------•........................••---...-•-------................---................. Phone%�....f?.� 5--� Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ../.. Number of bedrooms ---- Number of baths .1--- Lot size ............................................................ Supply: Public system 13 Community system ❑ Private ❑ Depth to Water Table ........ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe R Hardpan ❑ Previous Application Made: (If yes,date--------------------) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No 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_---,®-l-.Material_-- ?-��" ----------- 1 ® No. of compartments------ 91%;14V--------------Size-a?_ '-. - ' __Liquid depth.---- -- �r Capecity....................... Disposal Field: Distance from nearest well-----------------Distance from foundation--/`-"' Distance to nearest lot line._. .... Number of lines-............ ------------------Length of each line:-- -. �-'" r` P'#ci of trench------ __--'-__----------------- Type of filter material.... 6c_-?� -.Depth of filter material..._.aPf':..-.Total length..... -. �..._--. Seepage Pit: Distance to nearest well----------------------Distance from foundation__!! '..._--.Distance to nearest lot line......-...-...... ❑ Number of pits----------------------Lining material----------.------------Size: Diameter........................Depth................................. v 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-----------------------------------.-----. ❑ Distance to nearest lot line-------------- --------------------------------------....................................................................--------------------- Remodelingand/or repairing (describe):-----------------------------------------------------------------------------------------------------..-.....---------------------------•-------------- 4 --------------------------------------------------------------- -------------••----------------------------------------------------------------------------------------------------------------------------------------------- -----------------------------------------------------•------------------------------------------------------•-•---------------•---------------------------------------•---•---------•---------------. ---------------- 4 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, aanndd rules and regulations of the San Joa uin Local Health District. (100 (Signed) ��' �' � --.l�.�.-- ------.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--- ^-� --------------------- REVIEWED BY--------------------------------- -------------------------------- DATE----------------------------------------------------------- --- BUILDING PERMIT ISSUED.......- – ---------- DATE. Alterations and/or r commentt ions:..__ ---- - -- " . se .. ----------------------------------------•------------------------- ------•-•--------------------•----------------..------...-------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------- ------------------------------------- -- -------------------- -------- r FINAL INSPECTION BY:.---�._21w------ Date------'-]------------} C( --- .�q--....7 ...................... 1 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 51 REVISEa 9.69 2M 6-E1 gtkAs