12000 - Laserfiche WebLink

Home Browse Search

00 APPLICATION FOR SANITATION PERMIT Permit Nol- (Complete in Duplicate) Date Issued *6,_r,6_y_r_m_ This Permit Expires 1 Year From Date IssuedApplication is ade 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 N �- --7----- -----. ---------•--- I -------------- JOB ADDRESS CATION -- -- Name--- --------A ------------------------------------ - Phone------------------------------------ Address- *� ------- --- --------------------------------------------- Contractor's Name---------- -----`@--- � 1 Phon r .. Installation will serve: Residence Apartment House ❑ Commercial ElTrailer Court ❑ Motel E] Other [_1 Number of living units: f---- Number of bedrooms ---1-.. Number of baths / � � --- - Lot size ------��--`�-:---�--1p-�------------------ ---- Water Supply: Public system �( Community system ❑ Private ❑ Depth to Water Table Kr_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobqe Hardpan ❑ Previous Application Made: Yes ❑ 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.) ,Sgpti� c Tan Distance from nearest welt-----------------Distance from foundation--------------------Material------------------------------------------------- (f� u No, of compartments--------------------------Size---------------------------- ---Liquid depth-------------------------:Capacity----- -- --------` ispo el : Distance from nearest well...A1(1AF_-Distance from foundation__ /a--/---_-_.Distance to nearest lot line 15s jC Number of fines-- --------Length of each line---_ - --.T Width of trench.-.- " � -—of filter material-_--. sd_�__.__Depth of filter material---1 --------------Total length-----a�s.-_--_----------------_--- Seepage Pit: Distance to nearest well 15. :_--Distance fr�� foundation---- Distan�fto nearest lot line-- S--- ------------ ----- ------ ._---Depth_ � �Number of pits----------------------Lining material----1OSize: Diameter---- -73.._. (A 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----------------------------------------------- -------------------•-•-------•-------------------------- ------------------------------------- and/or repairing {descriibe) — ---------------------------- Remodeling _ i _1_5Z - ' -�� /------------------------------------•---_....... -� 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 reg lations of the San Joaquin Local Health District. (Signed)-------------- -� -- - ----- (-�' :=-----.---_ Owner and/or Contractor) B - (Tale) (Plot plan, showing size of lot, location of system in r ation to wells, buildings, , can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-.--- ----------------•-------------- DATE------- �-' 3 G= ��-------------- REVIEWEDBY--------------------------------------------------- ---------------- ------------------------------------------------ DATE---------------------------------------------------------- j BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- Alterationsand/or recommendations-------- -- --------------------------------------------------------------------------------------------------------•------------------------------------------ ---•------------------------------------------------------------------------------------------------------------------------------------------------------------------------•----------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------ ---------------------------------------------------------------- FINAL INSPECTION BY.. -f --- - --------------- ---------- Hate � �t..... --------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9 2M Revised 8-'59 F.P.CD.