15374 - Laserfiche WebLink

Home Browse Search

FROF1�1 1 US ..____ .... _... _________ ------ APPLICATION FOR SANITATION PERMIT Permit No. ... ------------ ------ ------ ------ (Complete in Duplicate) Date issued -------------------- --• This permit Ex fres 3 Year From Date Issued Application is hereby made to the San Joaquin Local Health istrict for a rmit to construct and install the work herein described. This application is made in compliance with County Ordina e No. 549. JOB ADDRESS A DtLCATION_.__ r______Owner's Name---•----- - ---• _ •----------------------------------- Phone----�---q, Address-------_------- Lo Contractor's Nam C - - ------.•- - V Phone Installation will serve: Residence [`Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ... __ N ber of bedrooms ___r_- Number of baths ___1_ Lot size_ ..,1.' ______--_.-_---__ Water Supply: Public system Community system ❑ Private ❑ Depth To Water Table �v ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe B-1 ardpan ❑ Previous Application Made: (If yes,date__ ......) No ❑ New Construction: Yes ❑ No 2--"F_HA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se Tank: Distance from nearest well-________________Distance from foundation--------------------Material_______.__-.___________.___-----..--_______.__... No. of compartments--------------------------Size--------------------------------Liquid depth--------------------------Capacity--------------._._..... Deal F' Distance from nearest well_________________Distance from foundation....................Distance to nearest lot line................. CA Number of lines-----------------------------------Length of each line--.----------_-------------•.Width of trench----------------•------.-.......... r Type of filter material_________________________Depth of filter material--------.--------------Total length------------------------------------------ 'g� Seepagp Pit: Distance to nearest well__ .tKer--Distance from oundation..../..Q.....Distance to nearest lot line----.l_p..l /PCNumber of pits---- ----------------Lining material___ vC ------Size: Diameter__ 111....-Depth_.. _ '-__---_.______ Cesspool: Distance from nearest well-----------------Distance from foundation_------------------Lining material___----___________________--_-_--____------------------------------------- M Size:Size: Diameter--------•------------------ ----------Depth_-------------------------------------------------Liquid Capacity...------------------------.gals. Privy: Distance from nearest well-________________________________________ _______Distance from nearest building------------------------------------------ F1 Distance to nearest lot line-------------------------------------------------•----•----------•--------------.. Remodeling and/or repairing (describe):------- - -- ----- ------ - -------------- -- --------•------•-----------------•-------------•--------•------------------ ---------•----•---------------••---------•----•-------------------------- ------------------- --------•-----•------------------ ----------------•----------------------------------------•--------••-------------------•---•----------------------------- •--------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, /fStaa�te lajw}s, and rules and regulations of the San Joaquin Local Health District. (Signed]___a�l -,C?� rte. rc.'�tl _ - — ---------------•----------------------(Owner and/or Contractor) By:-------------------------------------------------------------------------------- z - (Ti+le)--.... (Plot plan. showing size of lot, location of system in rola+ion wells, buildin , etc., can be placed on reverse side). � FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--.- = ; ---------------•---------------- DATE... f REVIEWEDBY------------------ -------------------------- -- -- -----------•-------------------------------------•--------------------- DATE--------------------------------------------- BUILDINGPERMIT ISSUED----------- ----------- -----------------------------------------------------•----------------------- DATE---------- --•--------------------------------------- Alterations and/or re mmend'ations ---------------------------------- ` ---__ --------1 - --•••- ._ ••�--- .- ,� --•-----•--•---------------------------••------- --------------------------•- •- ------------------------------- -------------- ------------------------- -------------------------- ------- ---.. -------------------------- ----------------------------------------- FINAL INSPECTION BY:-,-J--, Date----- -------- -�.7.G� -- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Strout Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED S-59 2M 5-62 ATLAS