9470 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. __/.-T_20__._ qN� (Complete in Duplicate) J �� 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. 5 D LOCATION_______//____ - . � JOB ADDRESS AN - -- ---------------- Owner's -------- -----Owner's Name ------------------------------- ---------------------------------------------- --------------- Phone-.--------------------------------- Address----------- ------------ - - ----------•----------------(-' ----------------------------- ------------------ ..---- Contractor's Name----------- --'- �2?T - -------- -- ------ --1-vr�` Phone Installation will serve: Residence {Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ 01 Nurnber of living units: __/__ Number of bedrooms _ '-. Number of baths `_-- Lot size _f X-___ ---------------_________________ Water Supply: Public system qrZommurfity system ❑ Private ❑ Depth to Water Tablay_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ Previous Application Made: Yes ❑ No E§`� New Construction: Yes ❑ No E�'FHA/VA: Yes ❑ No R�-- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) eptic ank: Distance from nearest well_________________Distance from foundation___________.------.Material-_--_-_._____.__._________._-_.__-.--_______--. No. of compartments--------------------------Size--------------------------------Liquid depth Capacity... Disp IJ. field: 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 it: Distance to nearest well_______ --____Distance fpom fou tlon____._,C.R__-____.Distance to nearest lot line---- Number of pits---/________________Lining material/2ize: Diameter--""'__ "--.__-_______- 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--------- ---------------- ------------ --•-------------------------------------------------------------------------------------------- 44VRemodeling 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, State laws, and rules and regulatio of the San Joaquin Local Health District. -------- (Signed) ---( Contractor) ---- -- ---By:---------------------------------------- ------ ------ ------------------------------------------(Title)- �� - ----- --------- (Plot plan, showing size of lot, to ion of system in relation to wells, buildings, etc., can be placed on rever side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY---------------------------- ~-------------------------------------- DATE------------------------------- ------------- REVIEWEDBY------------------------------------------------- -- 1-- ----------------------------------------------- DATE--------f— f �+-�-- --••----------------- BUILDINGPERMIT ISSUED---------- --------------------� '---------------------------------------------- DATE-------•---------------- ----------------------------------- F -- Alterationsand/or recommendations--------------- -------------------------------------•--------------------------------------...--------...---------------------....--------------•------------- --------------------------------------------------------------•----------------------------------------------------------------------------------------------------------------------...-------------------- ----------- ------------------------------------------------------------------------------------------------------------------------------------------------• •------- -----------------------------------•---------------------------------------------------------------------------------------------------------------------------------•----------------- ------------------------------------- -------------------------------------------- --------------•----------•-------- -- ------------------------------------------ ------------------•-----------------------•--------- �----------------------- Date----- L `5 FINAL INSPECTION BY:----��__P_A.__-- --------------------------------------------- l SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wes+ Oak Street 132 Sycamore Street 914 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E5-9-2M , Revises 1-57 F.P.CO.