17763 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. __/7...7..3. ---------------------------------------------------- --- (Complete in Duplicate) Date Issued -- � �-- ------------------------ ----------------------------- .._ This Permit Expires -- 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein de cs ribed This application is made in compliance with County Ordinance No. 549. ` JOB�__,DDRESS OCATION --- -- ------ /` - � X ------------------------------- Owner's =` ' Owner's Name------- --• --•- --------------•- -- --------- Phone.___....__ Address------------ ---------- ...2> - -.- -.._..------------ Contractor's Name--- -----. c-f--------------- •------ ---- �-----7—-- --- -- ---------------------------------••------ Phone----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _j--- Number of bedroomsNumber " baths ---I--- Lot size __- --_--_--_-__ Water Supply: Public system ElCommunity system E] Priv, Depth to Water Table -------- ft. l Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan Previous Application Made: (If yes,date--------------------) 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.) Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material--------------.-_-----.__-_-_.______--____--__--- ❑ No. of compartments----------------y-------Size-------------------------- ----Liquid dep`h-------------- -----------Capacity------------- ------ Dispos Field: Distance from nearest well-_-:- --_Distance from foundation-----1_�___ ___-Distance to nearest lot lines --..---_.___ Number of lines_--______/___ ✓___-.-___Length of each line__-__—IAOS-----_-__-Width of trench.-2-- a ---�--7_-__--_____--___ Type of filter material-_ ------Depth of filter material------ _-_______-Total length-------- ____--_____---_- ---- Seepa Pit: Distance to nearest well------��'-O_ Distance fro``'p�-foundation___---�©._-___.Distance to nearest lot line_____ ________ Number of pits....-_-j-------------Lining material;d._V--------Size: Diameter--.-_- _ -'.�__Depth-._�_--Ce_-_---------___- ` Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------------------------------- ❑ Size: Diameter.-'y---------------------------------De th----------------------------------------------------Li Liquid Capacity_. p q --------------- ---------gals'• -----gals. Privy: Distanca from nearest weiL------------------------------------------------Distance from nearest building_,____--______________________..__-__..._. Ql ❑ Distance to nearest lot*60 -------r----------- -- -------------'- -------------------------------- ------------------------------------------------------------ Ql ,f& e Inc or repairing (describe):-------- ---------------------------------------------------------------------- -------------------------------•----------------------- - ifl -------- ----------------------------------------------------------------------- --------------------------------------------------------------•--.------------------------------------------------------------------------- t ------------------------------------- ----- --------------------------------------------------------------------------------------------------------------------------------- --------------- > I hereby certify that I have prepared this application and that.the work will be done in accordance with San Joaquin County Y�Yi ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed) --------------- - ----'�- --------,----------------------------- ----------------- (Title) ------------- - �nd/or Contractor)`-`� aBy:..>. f - ----- ------ =- .r--- t ' - �."------------ ----{Titlej---------- ----- -- -------------------.......... .............. (Plo+ plan, showing size of lot, location�of.system to reation to wells, buildings, etc., can'be placed on reverse side). FOR DEPARTMENT USE ONLY, 1 APPLICATION ACCEPTED B ------- ----------------------t-----------------------------I- DATE----- ------ � --- . REVIEWEDBY----------------------------------------- --------------------------------------------------------- --- DATE-------------------------------- -- BUILDINGPERMIT ISSUED----------------------------------------------------------------------—-------------------------------------- DATE----- --------•------------------ ---------- ------------•-- Alterations and/or recommendations:-------------------------------------- ------------------------------------------------------ ---------------.------------------------------------------------- --------------------------------------------------------------------------------- ---------------------------------------------------•--------------------.---•-------•-----------------•----------•-----•------------------- -------------------------------------------------------------------------•-------------------------------------------------------------------------•------------------------------------- --------- ---•-•------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------•--•-----------------------•------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- FINAL INSPECTION BY: . -------- ------ Date '` SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave- 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED S•59 3M 3••63 F.P.ra.