15682 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. ---•---------- •--- ---- ---------------------- . `S_ ____-_ -Y ----------- --------------- ------------------------- (Complete in Duplicate) �f / _--------------------------------------- ---------- This Permit Expires 1 Year From Date Issued 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. 549. 449_,) : b S`/—zrp- 3/ ;�U' .�'O• �[.=�V i iE~'ttJ i2.��';g "� ' /fes,' , _..-` .Gll!�--------- 7 Phone JOB ADDRESS AND LOCATE N•----•------- .. �---=------ ---= '1+�.... .. ... ---••-... -----•-• Owner's Name------ --------------•-•-------------•-•--- Contractor's Name......... i ------------- Installation ---------Installation will serve: Residence M 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-f Depth To Water Table -r-_ ft. Character of soil to a depth of 3 feet: Sand Gravel Sand Loam Clay Loam Clay Adobe Hardpan P ❑ ❑ Y ❑ Y ❑ Y ❑ � ❑� Previous Application Made: [if yes,date.------_-..-------.1 No [�] i New Construction: Yes.a No E] FHA/VA: Yes ❑ No ❑4 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) , '® Septic 'Fank: Distance from nearest well.._4"P---_--..Distance fronyfoundation._-!a....-...--Material.T ------------------ ] No. of compartments------J+---------------Size-3-t&t`�-_--•.--------_Liquid depth_-'Y.-----.-------------Capacity_.&'----------- I flQ Disposal Field: Distance from nearest well-�0---------Distance from foundation__f.!?._-----------Distance to nearest lot line-d-�____.....I X33 © Number of lines----__/_---_ .-_ Length of each line...�>10..................Width of trench---�-Y_G--_-------_.------ Type of filter materia ._.-- e� V4- --Depth of filter material---- �'-_-------_.-Total length----- -�...............•----_--- Seepage Pit: Distance to nearest well«-------------Distance from foundation_-_,f_-C '........Distance to nearest lot line.S:...........1 -h ; [ ] Number of pits----.r-------------Lining materiaO,_ --------.--.Size: Diameter------1V_*-----------Depth--.,;�L'r----------------------- 17, Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material...................................... ❑ Size: Diameter-------------------------------------Dept h----------------------------------------------------Liquid Capacity----------------------------gals . I Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----------------------------------------I IDDistanceto nearest lot line--------------------------------------------------------•-------•-------•-------•-----•---------- ---------------------------------------- I Remodeling and/or repairing (describe)-----------------------.------------------------------- -----•---------------•-----...._-_..-...---•----•---..---......•............••....----------------•-----------------•--------------------•-----------------------------•-----•------••-------•-----------•--------.----------- --------------------------------------------------•---------•-------------------------------------------------•-----------------------------•-----------------------------•-----------..------------------------------ hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Count ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed) ---------- •- -•-- •- - -------------(Owner and/or Contractor By:.- --------- --------• ---------------------(Title)----------,---------------------------------- -- -------------- (Plot plan, shawin size of ot, a ion of syst in re ation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- -------------------------------------------------------•---- DATE-- -' _76-3-------------------- ----------------- REVIEWEDBY------------------ ------------•----------------------------------------------------------- DATE---------------------------------------- ------- ----------- BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE-------------------------_-------------------------------- Alterationsand/or recommendations:-•---------------- ------------ •---•-------- ---------------------------------------------------------•-•--•-•----••---...-------------•----•-------------.--- -----•------------------ ------------•----------------•---------------------------•----------------•--------------••-.----•---•----•---.-..-...-..---...-----------•-------------------------------------- -•--------------- -------------------•-•-------•-----------------------------•------------ -----------------------------------------------------------------------------------------------------------------------------------------•---•---- FINAL INSPECTION BY:_4, - -. .�- �--•--•-----------•---. Date---- - SAN JOXQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED a-59 2M 5-62 ATLAS