18548 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE:" dwp,. --------------------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. _ U....._.. ... -------------------------------------------------------- Date Issued -------------------- ------- - (Complete in,Du Duplicate)P� ] This Permit Expires 1 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 compliance with County Ordinance No. 5 49. JOB ADDRESS AND LOCATION__ �J Owner's Name--------L- - `, -- --- ------ - ----- --- ---------------- --------=-- ----------------------- Phone_---------------------------- Address - '-- `- -------- ----- - - � t - Contractor's Name-- Installation will serve: Residence k] Apartment House❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___I___ Number of bedrooms _ _-- Number of baths J____ Lot size ._ ______. _ __________________________ Water Supply: Publie�js stem ❑ Community system ❑ Private E� -Depth to Water Table r ft. Character of soil to a depth of 3 feet: Sand [j Gravel ❑ Sandy Loam [o Clay Loam ❑ Clay ❑ Adobe 2] � Hardpan ❑ f Previous Application Made: {1f yes,date----------_---------I No ❑ New Construction: Yes ❑ No ❑ FNA/VA: Yes I] No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: C' - (No-septic-tank or cesspool-permittedmif public.sewer is available within.200.feet.) Septic Tank: Distance from nearest well---%Y O -__Distancefrom foundation---/_ -•--- Material__ ___ ______ PC _ No. of compartments__ __________________Size--- a -t__ � Liquiddepth--------_ ---------------Capacity Disposal Field: Distance from nearest weil_S-O-__`'__;Distance from foundation-----IP__q_____-Distance to nearest lot line___________ pq Number of lines______ _____ _______ engfh of each liner---/_13_fl__ '_-L�Q_.Width of french---3�*__-_.___________-_--- Type of filter materi Depth of filter material_____f_ _________Total length-_ Q_'0--------------------------- Seepage Pit: Distance to nearest we I____________________'Distance from foundation_____._.__________.Distance to nearest lot line_______________-_ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter---__•-----------------Depth---.----------------------------- Y f r $ Cesspool: Distance from nearest well_____-I____ l}istance from foundation------------------- Lining material------------------------------------- ❑ Size: Diameter--------------- -------------- Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest wel _____________________________________Distance from nearest building----------------------------------------- ❑ Distance to nearest lot line:- ------ -----------------------------------------------------••------------ 1 Remodelingand/or repairing;{describe]=--------- - ------------------------- -----------•---•-------------------------------•-------------------------------------------•---------------------•- I------------------------------------------------------- . i { ------------------- ------------------------------------•-----------------------------•------------------------------------------------------------------------•--------------------------------- --------- I hereby certify that I have prepared this application and +hat the work will be done in accordance with San Joaquin County } ordinances, State laws, and rules and regulations of +he San Joaquin Local Health District. (Signed)__ --.. (Owner and/or Contractor) = (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 •R Y APPLICATION ACCEPTED BY--- ------------=---------------------------------------- DATE---,2 --------------------------- REVIEWEDBY---------------------------------------------------------------------- ------------------------------------------------------ DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED--------------------------------------------------------------------------•-------------------------- DATE------------------------------ ---------------------------- Alterations and/or recommendations-------------------------------------- ------------•-----------•-----------------------------------------------•--------- „ -•-----•---------------------------------------------------•--------------- ------------------------------------•----------------------------------------•--------- ------ --------------------------•----------•----------- -------•-------------------------------- ------ --------------------------- ---•---•-- ------------------------------- -----------_-------•-----------------•------------------•------------------------- ----------------------------------- - - FINAL INSPECTION BY:- 4 --------------=--- Date--- g_-f`�r s`------ - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.tfa:eltan Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REVISED 8-59 31A 3-'63 F.F.CC. s � f �