11444 - Laserfiche WebLink

Home Browse Search

ATION FOR SANITATION PERMIT Permit No. __1 - "--- • APPLIC .-.q (Complete in Duplicate) Date Issued __f \1�1lication-is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. APp 't This a lication'is made in compliance with County Ordinance No. 549. i :,� pp. f o - - --- ------ - �' ----------- � ' ' ---------------------------------------------------- ------- JOB ADDRESS A CATION__.__/S --------ter --- ---------------------- Phone -------------------------- -------------- Address Owner's Name_-_____ —� Address--------- ✓ �'rs = � eo- Contractor's Name--- -- -------- Residence ----------- Phone - - r- Installa+ion will serve: Residence ❑ ` Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: -------- Number of bedrooms -------- Number of baths ------- Lot size ---------- =' � '' Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table--------- ft. Gravel Sand Loam ❑ Clay Loam Clay ❑ Adobe ❑ Hardpan ❑ Character of soil to a depth o 3 feet: Sand ❑ ❑ Y No El Application Made: Yes E] No New Construction: Yes Yes No FHA/VA. ❑ 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---- ----------- -----Size--------------------------------Liquid depth_----------------------- Capacity Q-_- -_.Distance to nearest lot line--- ----_.-.Distance from foundation_- i i• pis os 1 Field:. Distance from nearest w !I _ Length. of each line-- Width of trench..- 7��__________________ Number of lines--------- --- 9 - y� - r Type of filter material---_ � --Depth of filter material_----__� ---------Tota4 length_-___-rz ------------- AddSeepage Pit: Distance to nearest well-------------_-------Distance from foundation---_____.---.._-.--.Distance toDnepfk--- lot line__---_-_-_____-- [ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter.------------------ - -- } ------------------ 4 Cesspool: Distance from nearest well.-_-------------Distance from foundation----'- -----------" Llquid Capacity-._.---._----__--- gals. Depth --------------- Size: Diameter -------- ------- ---------------- ' { Distance from nearest building--_--------------------------------- Privy: Distance from nearest well----------------------------- r Distance to nearest lot line _- _-- 1 Remodeling and/or repairing [descriUe):_.__� 1-•-----' � � _-- ------ -- - ----------------------------------------------- ------------°----------------;---- ------- l '-----------1-- - 5 -- --- - --- - - - -------- ---------- - ---- ---- --------- ------ ------ --- - ---- - 1 hereby certify that I have prepared +his application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and re of the San Joaquin Local Health District. ' (Owner and/or Contractor) (Signed) - -- j � ,_ ---- -------- -(Titles- ---- ---�---------------- V. By' -------------- ---------------------------------------------------- Wells, (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). I FOR DEPARTMENT USE ONLY PP Q-s DATE-----J!_-".� .' -- - ------------------------ - ------------- -- APPLICATION ACCEPTED BY-_-'~T,- --'- -- ------- --------- DATE------------------------------- REVIEWED BY -------------------------------- -- DATE----------------- BUILDING PERMIT ISSUED------------------------------------------------------------- - ---------------------- ------------------------------- --------------- Alterations and/or recommendations------------------- --- ----- --------- --------------------------------------- -- I --------------------------------------- ----------------------------- FINAL INSPECTION BY� ------------------------------------ —7 ------- ------------------------------------ = SAN JOAQUIN LOCAL HEALTH DISTRICT 132 S camore Street 814 North "C" Street 130 South American Street 300 West Oak Street y • Stockton, California Lodi, California Manteca. California Tracy, California Revised 1-57.F.P.CO.