12123 - Laserfiche WebLink

Home Browse Search

F APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued ____ _�..../6e2 This Permit Expires l 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 described. This.application is made in co pliance with County Ordinance No. 549. /`� ` `"2-,(0—DI JOB ADDRESS AND LOCATION. -c� .��-------- /�� fp°' Owner's Name 'el Phone •-------------------------- /v -------- -----------•------ -------------------------J--------- --- ----Address----------- - '----- Contractor's Name --------------------------------------------------- -------------------------------- Phone----------------------------------- Installation will serve: Residence 0 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --I---- Number of bedrooms _ ___ Number of baths A____ Lot size ----/#"F!47yS__b_____________________________ Water Supply: Public system ❑ Community system ❑ Private DJ Depth to Water Table A10- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy loam ❑ Clay Loam ❑ Clay ❑ Adobe 5� Hardpan ❑ Previous Application Made: Yes ❑ No DJ New Construction: Yes No ❑ FHA/VA-. Yes ❑ No ❑ TYPE"OF- INSTALLATION AND SPECIFICATIONS: j (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I �' O Material ----------- --- - Septic Tank: Distance from nearest well-____-_--'=Distance from foundation--_l_____ _ _ No. of compartments----3- ---------Size_2... �e_a*,n 71`' Liquid depth---_y'----------------Capacity Zao--------• Disposal Field: Distance from nearest well..Z''00----_____Distance.from foundation_j�!?."----------Distance to nearest lot line_ ---------- i Number of lines___s'F'r__-___r _______________Length of each line__77__�__'-----------------Width of trench__,;_L___y------ Type of filter materia _�d�_Depth of filter material__h�-_".__________.Total -length---` =�"Q '_ i Seepage Pit: Distance to nearest we L_l__1_9__-_-___Distance from fou dation___qP______.___.Distance to,-nearest lot line----------------- w a- --Size: Diameter 3 3------------Depth----�` --------------------- Number of pits_____ ._____-.-._-.__Lining material-J�.___ Cesspool: Distance from nearest well_________________Distance from foundation_._._______----____.Lining material---._--_--.___-__-_____________--.-. F-1 Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity---- gals. r Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ f, F1Distance to nearest lot line------------------------------------------------------------------------------------------------------------------------------------------ 'h Remodelingand/or repairing (describe)----------------------------------------------------------------------------------------------------------------------------------------------------- ---------- ------- --------------------------- L --- ------------------------------ ---------------------------------------- ---- ---------------------- ------------------------------ -------------- - . . - ---- ------- ---------------------------- ------------------- ---- 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)---- ---------' -------------------------------------------------------------------------------- - (Owner and/or Contractor) • - - By:------------ --- ---------------------------------------------------------------------------------------- (Title) (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-All, ---------------------------------------------------------- DATE 6l= r- ----------------------------:- REVIEWEDBY----------------------------------------------------------------------------------------------=-=----------------------------- DATE---------------------------------------------------------- - BUILDINGPERMIT ISSUED---------------------------------------------------------------------`----------------------------- DATE-------------.---------------------------------------------- Alterationsand/or recommendations-------- ---------------------------------------------------------------------------------------------•----------------.-------------------------------------- ---------------;------------------------------------------------------ --------------------------------- - ----------------------------•------------------------------------------ -------------------------------------------------------------------------------------------------------------------------------------•--- ------------------------ ----------------------------------------------------- ---------------------------------------------- ------------------------------------------------------------------------ ------------ ------------------------•--------- ----------•-------•------------------- ------------------------ FINAL INSPECTION BY• ------------ ' Date----- r �° 0 -------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California t ES-9-2M Revised 8-'59 F.P.Co.