8979 - Laserfiche WebLink

Home Browse Search

v � ,...t (� / APPLICATION FOR SANITATION PERMIT Permit No. _!�.-��_�-_ b 1 (Complete in Duplicate) 7 ^ 1 �1� Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. his application is made in compliance with County Ordinance No. 549. ' JOB ADDRESS LOCATION--------�'��--�-- '�G ---------------------------- p�, �7... Owner's Name 4 --- ------ Phone �� ------------- Owner's Name ------ ----------------------------------• --------------------------------------------------------------=----------------------------------•-------------------------- Contrattor's Nama_ ___._= 1 ��= Phone ____ -_ �. ._ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court Motel ❑ Other ❑ E r d Number of living units: -_r_--- umber of bedrooms _ Number of baths ___---__ Lot size _- � --- __ __ �--------------------------- Water Supply: Public system 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 Hardpan ❑ Previous Application Made: Yes ❑ No &I", New Construction: Yes,KNo ❑ FHA/VA: Yes ❑ No 2" TYPE.OF INSTALLATION AND SPECIFICATIONS: ~-- (No septic tank or`cesspool permitted if public sewer is available within 200 feet, Septic Ta c: Distance from nearest well-----------------Distance from foundation-------------_------Material________•_.____-.-----.._.--_--------,_-----. No. of compartments---- ---------------------Size-------•--------------------=---Liquid depth-------------- ------ Capacity---- ----- ------ Disposal Fiek Distance from nearest well_________________Distance from foundation--------------------Distance to nearest lot line--_----.__----_-- �� Number of lines-----------------------------------Length of each line------------------- '------Width of trench------------------------_--------- Type of filter material-------------------------Depth of filter material----------------'______Total length------------------------------------------ ?.- __-_______._.____ __________.____._.,__.,,- / ' _ Seepage Pit: Distance to nearest well:µ_ f}_�_ _`__Distante from foundatioii_j.6.._""_-__._..D e to nearest lot lire__ ___________ Number of pits______--------------Lining mater�al---�`2�___.__.Size: Diameter__ � p Cesspool: Distance from nearestwell-----------------Distance from foundation--------------------Lining 'rivy: F material---.--.-.___-----._--_---___--___ -_-. gals.Size:.Diameter------- ----------- ----- --- De th------------------------------------ Li uid.Ca acitY - Distance -------------------------------------- from nearest welt_________________ -_.-------- ---.....Distance from nearest buildin ❑ ; Distance to nearest lot line--------------- -'�- Remodeling and/or repairing (describe): ---- - ----- - - = # ---------------------------------------------------------------------------------=--------------------------------------------------------------------------------------------------------------------- ------------------- --------------- ---------------------- -------------°------•----- f---------------------------------...__.--- -----•-- ------------------------------------------------------- ------- ----------------•--------.--------------------------- l A _______________________________________________________________________________________________________________.___------__._-----_----__________________.._.______..._._______________.--__----_----_----_-._- I hereby certify that I have prepared this application and that the work will be done in accordance. with San Joaquin County ordinancoa ate laws, and rules and regulations of the San Joaquin Local Health District. % ! (Signed)... --- ------ ---------- --------------'--------------------------------------------------------=------- .-(Owner and/or Contractor) - - ----------------------- (Plot plan, showing size lot, location of system in.relation to wells, buildings, etc., can`be placed on reverse s e). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY---------------------- ------ ----------------------------------------------------------- DATE--------- --------------- --------------------------------- ,- REVIEWED BY----------------------------------------------------- -- -- - ----- - -- -------------------------------- -- -•------- bAT1=---------- -%---- BUILDING PERMIT ISSUED-------------= � ,.. - = DATE---------------- - ms Alterations and/or recommendations:-_-_-_-.___ ------- �______ ----------- a� , .. -..________________________________-------- __----------------------------------- ___________________________________________________________________________________ _________________________________________--------------------------------- ------------------------------------------- ------------- ----------------------------------------------------------------- --- ------.__-----...------.--_--._..,-_--__-_--_-_---_-__.-____-_..___.__--_-___-__--__-.___-_-- l,r ;• j i ,FINAL INSPECTION BY:� -----------------=-----•--------- ------ D ate ��-•---------------•-------------------- 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 h� ES-4-2M . Revised 1-57 F.P.CO. 4 6 -�