19961 - Laserfiche WebLink

Home Browse Search

'FOROFFICE USE: T • - 1 =al 5 --------------- l ....------------>/. 'rlr APPLICATION FOR SANITATION PERMIT Permit No. `- = 'r---- ---- ------------------- (Complete in Duplicate) # 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. JOB ADDRESS AND LO AT ON___ - ---`. .--_ Owner's Name �� ° - Phone.. ------------------------ Address ----------------- ---•-Address , �._ -� Contractor's Name------J ------------------------------------------ ------------- ------ Phone----------------------------------- Installation will serve: Residence @Apartment House ❑ Commercial E❑ Trailer Court ❑ Motel ❑ Other ❑ ' t .01Number of living units: _1.� . Number of bedroomS�.. s ___ Number of baths ./n__ Lot size s, "/ r�-------------------------_--- or Water Supply: Publicsyst � �ommunity system ❑ Phivate`❑ Depth to Water Table"ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ il.Sandy Loam ❑ Clay Loam-0— Clay ❑ Adobe Zj--nardpan ❑ Previous Application Made: (If yes,date--------------- No 52-'New Construction: Yes ®/No ❑ PHA/VA: Yes ❑ No g 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 w ��__-.-_Distance f om fou dation___�,f�-__--...Material_. -----t �.�/4 Info, of compartments---- _______________$ize.��t��(@iquid depth_...-�f914 Disposal Field: Distance from nearest well----....-----.---listance from foundafion.__,_1W.._....Distance to,nearest lot line..rr ---------- ®� i Numbe}of Eines ate' Length of each line.J � Width of trenchF Type of`filter materialf-I _ / Depth of filter materiaL._� `_._Total length._�10_2P_'-------------------- \\� f Seepage Pit: . Distance to -nearest`well.._..�^-_.---Distance from fou dation:.,,��._-.__- Dista�c�e to nearest lot Ike.. ....... ( dumber of pits... -....._____Lining maferial_ -Size: Diamefer__S ....-..__.DeptFs_r ._/ : Cesspool: Distance from nea est well-----------------Distance from foundation._-__- ----.......Lining material---------------------------- ---------- ❑ i� Size:.Diamefer___. 1.,a-------------------- ---------Depth---------------------------------------------------Liquid Capacity---------------------------gals. Privy: Distance from nearest well_________________-.........__---_-.-_______---.-DistaLe from nearest building..-- .______----..____-.----- ❑ Distance to nearest lot line------ --------------------------------------- 1 Remodeling and/or repairing (describe}: ~/i I -- -------•----------------------- ------------------------------------------------- ------ -------------------------------------------------------•--------,--------------------------------------------------------------- ---- ------•------------- - --------------------------------- --------------------------------------------------------•------------•---'-------------------------------------------------------------------- I hereby certify that 1 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.. { 5i ned /�� a { ( g )------------ { Contractor) BY:---------------------- -------------------------------------------------------- -- �--- - -- - - �---------Title--- (Plot plan, showing size of lot, location of system in rel n to wells, buildings, etc., can be placed on reverse side). I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -. ----------------- DATEZ.Z__�_/- �P-i- ------------- REVIEWEDBY_-.------------------------- ----- --------------------------------------------------- -------------------------------------- DATE------ ------------------------------------------------ UILDING PERMIT ISSUED------------------------------- -------------------- DATE. Alterations and/or recommendations:-,4.2----.2/n---&_ " 2— ------P ' V -----•------------ - ----------------------------------------------------- -- - --------------- ---------- ------------------------------------ ----- - i + I F1NAL INSPECTIONBY:.' Date. a �' �r --------------- SAN JOAQUIN LOCAL HEALTH DISTRICT s„ r 1601 E.Ha:elton Ave, w 300 West Oak Street % 124 Sycamore Street 205 West 9th Street a - Stockton,California Lodi,California IVlanteca,California Tracy,California r.a.00.