18757 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. .........----_.....-.,- ------ ------------------- -------- -------- (Complete in Duplicate) AA/l ------ -- .--- This Permit Ex ires 1 Year From Date IssuedDate 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 Or inance No. 549. �j 6, f_ 1 L(O-o ! JOB ADDRESS AND LOC T10N_ _ -------- ��!-i---� - -------- Owner's Name------ ----• ------- ------ Phone------------------------------------ Address � 6 . ir� ------------------------ "` `�' ____ Contractor's Name -------------------------------------------------- _ rf - ` �. r .. ------------------------- ------------------ --- hone----------------------------------- Installation will serve. Residence,] Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _1---- Number of bedrooms Number of baths __/.__ Lot size .-_ ______________________________ Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table W ft. Character of soil to a depth of 3 feet: Sand [] Gravel [❑ Sandy Loam Ig Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (if yes,date____________________) Na ❑ New Construction: Yes ❑ No ❑ PHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: _ y (No septic tank or cesspool permitted'if public sewer is available within 200 �- Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material____._________________________----__.___.._______- ❑ No. of compartments--------------------------Size--------------------------------Liquid depth------------ - -----------Capacity----------------------- N Disposal Field: Distance from nearest well.J-D7......Distance from foundation__/-q-----------Distance to nearest lot line_`--.____-_ � Number of lines_____ _____ _____ Length of each line---/-0-2______...______.Width of trench.._. _y__________________.._ Type of filter ma ---------------------------------- i Depth of filter material - Total length ----�------------------------------ xr Seepage Pit: Distance to nearest well______________________Distance from foundation--------------------Distance to nearest lot line----------------- 0 ❑ Number of pits----------------------Lining material----------------------.Size: Diameter-----------------------Depth---------------------- ---------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- 3 F ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well __._______...----------------------------------Distance from nearest building.____.__________________________________- ,l ❑ Distance to nearest lot line--------------------- 71 Remodeling and/or repairing {describe)___ ___ ______ __Y �_____._ -_-__-_--___________-_________ 1 --------------------------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------•------------------------- -•-------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------- - ----------------------------------------------------------- ---------------------------------- -- - ------ ------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinanc4Sfalaws, and rules and regulations of the San Joaquin Local Health District. SI ned Q-+n-'� ._. _w____ _.__Owner and or Contractor( ig )-- ---- ------ ------------------------------------------- ( / ) ---- By: - --- ---- ------------------------------------------------------------------------------------------(Title)---------------------------------------- - - - - --------- (Plot plan, showing size of lot,"location of system in relation to wells, buildings, etc., can be placed on reverse side). 3 FOR DEPARTMENT USE ONLY ,,yy APPLICATION ACCEPTED BY___ ._ __ _ ____ DATE_____J_' U -4_-:r , - ----------------------- REVIEWEDBY------------------------------------------------------------------------------------------------------------------------------ DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED------------------------------------------------------ ----------------------------------------------- DATE---------------------------------------------- -------------- Alterations and/or recommendations:------- -- -•- --- ---- -------------- ----- - ------•-------------------------------------------------------------------- -----------------------------------------------------------------------•------------- ---------------------------•----------------------------------------------------------------------------•------------- •--- -------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•------------------- ------------------------------------ --------------------------------------------------------------------------------------------------------•--------------------------------I----------------------------------------------- ----------------------------------------- ------------------------------------•----------------•----------------------------------- ---------------------------------------------- ---------------------------------------- FINAL INSPECTION ------------------------------- - Date - (` `/-------------------------------- -------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED B-59 3M 3-'63 F.A.40.