18862 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: __________________________________________ APPLICATION FOR SANITATION PERMIT Permit No. ..l- ___7, --------------------------------------------------------- (Complete in Duplicate) Date Issued ___!__ -�__ -- ---------------------- --- --- ---- --- --------- - Issued k-- Application This Permit Expires i Year From Date 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. 549. JOS ADDRESS A D LOCATION- ; - _, KKh.- s-�f -�e1 --- ' A.�r -- c ---------- (3-----C>�f� -2� r Owner's Name--- --• ---- -- ---------------------------- Phone-----------_----•---••------------ Address......... - = -------- ------ .---- - --•-- 1 Contractor's Name----- - ----- - �--� ------------------- ----- - -- hone.-_!-__�.�_�`—"._ Installation will serve: Residence ]d 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 e 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: (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.) Septi ank: Distance from nearest well_____S©_-__Distance from foundation___.� - - Materiai------Cry _______________ p q p f ----Capacity...1�-��r No, of compartments uid de th___�_______________ Disposal Field: Distance from nearest well____S -----Distance from foundation------/-_*----___ Distance to nearest lot line---- D!r Number of lines_________ _--______-Length of each line___ Width of trench__a ---_________-__________ Type of filter material___��E___r_--------Depth of filter material_____L-9__----------Total length----t�_4<¢_°____________________ Seepage Pit: Distance to nearest well---------------------- from foundation____-_-_-____-___.Distance to nearest lot line_____-__________ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth--------------------------------- Cesspool: Distance from nearest well----------------- from foundation--------------------Lining material------------------------------------- 7 ❑ Size: Diameter------------------------••----:-------Dept h----------------------------------------------------Liquid Capacity---------------------------.gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest buiJd;ng--------------------------------------- 0 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, State laws, and rules and regulations.of the.-San Joaquin Local Health District. (Signed) - -------- rand or Contractor BY �"� ----------------------(Title)----------------_- ----------------- - ---- --------- (Plot plan, showing size of lot, location of system in relation toe'W lls, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- ---------------------------------------------- DATE---'--/- ---------------------- REVIEWEDBY----- --------------------------------------- - ------------------ ---------------------------------------------------------- DATE----------------------------------------------------------- BUILDING PERMIT ISSUED------------------ --------------------------------•------------------------------------------------ DATE---------------------------------- -------------------------- Alterations and/or recommendations--------------------------------------------•-----------------------------------------------------------•-------------------•---------------•------------------- ------------------------------------------•---------------------------------------------------------------------------------------------------------------------------------------I—------------------•-•-•-------_ --------------------- ------------------•--------------------------------- ---------------------------------------------------------•------- -----------------------•---------------------- ------------- ------------------------------------ ---- ----------------------------- FINAL INSPECTION BY:------/, ' '- / ---------------- Date-----15r/_ ---------------------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9Th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 6-59 3M 3-'63 F.P.CC.