12972 - Laserfiche WebLink

Home Browse Search

P FOROFFICE= USE- APPLICATION FOR SANITATION PERMIT Permit No. ./ -------------------------------------------- ---- --- (Complete in Duplicate) _._._ This Permit Ex ices 1 Year From Date Issued Date Issued 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 549. JOB ADDRESS AND LO TION 0 _;------------------------- ------- ----------------•------------------------------------••-- Je � Phone... -------- Owner's Name-----44/ - -- -------------------•--------------•----•-------- ------------------------------ Address--------- - ---•-•----------- e�---•-------- Contractor's Name---------------ill �!~' �___ _._ _. --- -- _ ------ -------------•------------------------------------------------- Phone-- ...... Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms __A- Number of baths __1.-- Lot size .%J--� ---/"�.____________________________ Water Supply: Public system ar-c-ommunify system ❑ Private ❑ Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe&,-Aardpan ❑ Previous Application Made: {lf yes,dcste--------------------) No New Construction: Yes ❑ No [�rFHA/VA: Yes ❑ No r: TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) SFetic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material------------------------------------------------- No. __- --.______-______________________._---_.___-.No. of•compartments---------------------------Size_------------------------- ---Liquid depth----------------------:...Capacity------ ---------------- Disposal Figld: Distance from nearest well------ "J_____Distance from foundation._/**;�,_/. _.Distance to nearest lot line__%.0+ X r/�i9 Number of lines----------_.__ _________Length of each line_____ -----------Width of trench__ ,�_'11_______________________ Type of filter material-�_ -_ . 46Depth of filter material____. ________Total length___ .�__ _--__________________ Se a e Pit; Distance to nearest well.___ ----------Distance fr m fou dation___ p._.____.D�ta 07 �e to nearest lot {ine___+,r _ ______ �Wo y Number of pits-__________________Lining material----/ 1�rSize: Diameter_,�_�_.___ ___Depth___�R_/___.________. 1 Cess 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--------------- ------•--- -----------•-----.---•------------•-----------.-----•--------------•-------------------- Remodeling and/or repairing (describe):------------ - ------------------------------------------------------------------•-------------------------------------------•------- � �--�----------------------------------------------------------------------- ------------------------------------------•---------------- --------•------------------------ ----------------------------------_: ------ •------------- --------..-------------1----------------- I ------------------ 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, and rules and regulations of the San Joaquin Local Health District. (Signed) - (,.m.we-andor Contractor) By: ----------------------------------------- --------------------------- Title -- - ------f---_--_ --------------- (Plot plan, showing size of lot, location of syste n relafion to wells, buildings, etc., can be placed on reverse side). FOR DE FARTMI;NT USE ONLY APPLICATION ACCEPTED BY--..--. _ - -- - -------------------------------------- DATE_..-_�3_ .-- --- --_t>�-------.-------------------- REVIEWEDBY----------------------------------------------- --- -------------------------------------- ---------_---------•-- •-----•- DATE----- -----•-----------.--------------------- BUILDINGPERMIT ISSUED---------------------- -- ---------------------------------•----------------------------------------- DATE_---------------- ------------------------------------------ Alterationsand/or recommendat ions:----------------------------------------------------------------------------------------------------------------------•-------•-------------------•----------- ------- -- -- -- ------------ ---- ---I-•--•----••i�---•- •- -- ----- - ------ _ - - -------------------------------- ----------- ------- -•-----•----------_- - - -- ---•-•--•--•----- L ----------------- ------- -- ----------------------------------- --- - i��/ Z �� ---------------- -- -- - -----------•• -- - -------- r t - - C ---------4 FINAL INSPECTION BY. ---G ---- - --------------------- Date------ -1_1 - 9 ------------------------------------ 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 E9-9 REVi6[O 9-59 F.F.CC.2M 6.60