12300 - Laserfiche WebLink

Metadata

Thumbnails

Annotations

i APPLICATION FOR SANITATION PERMIT Permit No. J a 3o a (Complete in Duplicate) a, 60 This Permit Expires I Year From Date Issued Date Issued _"-3_____-_----- i Application is hereby made to the San Joaquin Local Health District for a permit to construct an install the work herein described. This application is made in compliance with County Ordin nce No. 549. JOB ADDRESS AND LO ATION -.- = -_ � �,_ Owner's Name---- -------------------------------------------------------- -- --------------------------------------- Phone------------------------------------ , Address ... �Y`'- -----------•--------------------•-------------------------- Contractor's Name --•---------------------------------------- --------------------•-------------------- Phone.------•-----........_..__... t Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: _' ___ Number of bedrooms _ ___ Number of baths __ .._ Lot size .__ __ IWv__._____--_ v Water Supply: Public system ❑ Community system ❑ Private M Depth to Water Table%.D-- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam N Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ 1 No 1A New Construction: Yes No ❑ FHA/VA: Yes ❑ No ❑ # TYPE OF INSTALLATION AND SPECIFICATIONS: i (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well---_.;r-_.-Distance from foundation---_1- Ma�te��rial___!N-"' J� _--------___ �] No. of compartments---------.-------.----Size-- - --- - -- ------Liquid depth------I- E` -------------Capacity-� _t7---------- Disposal Field: Distance from nearest well--- ___-Distance from foundation__ -------------Distance to nearest lot line_-*---1[-____--. Number of lines-I____ -________ _____ ___Length of each line____1.9"D____________---Width of trench----�`'f-"'_._____________.___ Type of filter materiaT��___"__��S LDepth of filter material ____1_%_..r-- --__.Total length__ - -0 ------------------------ Seepage Pit: Distance to nearest well______________________Distance from' foundation--------------------Distance to nearest lot line----------------- E-1 Number of pits----_.--------.-....Lining material---------------s------.Size: Diameter-.---------------------Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation------------------..Lining material--------_____________________________- ❑ Size: Diameter-------------------------- ----- ----Depth------------------------------ ------- --------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well_______________ _____________________________Distance from nearest building------------------------------------------ ❑ Distance to nearest lot line------ ----------------------------------------------------------------- Remodeling and/or repairing (describe):------ ----------------------------------------•----••--•---------------------------- ---------•-------------------------------•------------------------ --•-----i----------------------------•--------------------------------------------------------------------------- -------------------------°----------------------- ---------------------------------------------- ... --------------------------------------------------------------i -------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------- ------- ------------------------------------------------------- ----------------------------------------------------------------'-------------------------•------------------------------ --------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat la and r [es and regulations of the San Joaquin Local Health District. (Signe � ' `' 4 t-------------- - __--.--____________._._.(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 i may- APPLICATION ACCEPTED BY [ f---------------------------------------------------------- DATE--- A- REVIEWEDBY-------------------------------- ------------------------------------------------ -------------------------------------------- DATE-------------------- BUILDING PERMIT ISSUED--------------••I- ------------------------------------------------------------------------------------D--A---T--E Alterati ATEAlterations and/or recommendations:1------------------------------ ----- - --------------------------------------------------------------•--------------------------•---•-------•--------•-•-------- -A- -- --------------------------•------ ---- --------------------- -- -- --- o- . - _ ----------------------------------------------------- ------------- ------ ---------------------------- ------------------------------ - ----------------------------------------------------------------------------- - ,306/ FINAL INSPECTION BY:..- .2-------------------- --- `, � � Date--- ------------------ -----•---------- - ---------- ---------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Mante", California Tracy, California ES-9---2M Revised 8-'59 F.P.Ca.