13087 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit (Complete in Duplicate) JJ Date Issued ----- Application is hereby made to the San oaquin"Looccaal 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 D L AT O� ----- --Jam---- -..............f. t -- _ Qom► Owner's Name--- ...` -rr--------------- -_- �----------------------------------------------------------------. Phone................... Address--------------- ------ 7.Q----- ----4----�'"/"----------- ------ ----------------------------------------------- Contractor's Name------ --- ---- --------- ----------- - --------- ----------------------- ----------------------------------------------- Phone----------------------------------- Installation will serve: Residen k� Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---I--- Number of bedrooms _-A. Number of baths __/--- Lot size ____._ B_. __� + ___________________________ Water Supply: Public system ❑ Community system Ar�llf Private ❑ Depth to Water Table Character of soil to a depth of 3 feet: Sand x Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan❑ Previous Application Made: Yes ❑ No New Construction: Yes,&_& ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well___�a-----Distance fro found ion__�.V-----------Ma eripl_-__-_ �osal No. of compartments_--�_______________Size__.�_X__--_,x__ _Liquid dee�p.th___�_---2, ._Capacity___,_li-o___DisField: Distance from ne est well-_,51____Distance from founds ion_-.-_lss?-____-.Distance to nearest I fire `f> .......___ Number of lines______________ ____________ Length of each line 'Q_T..� ___ ltrdth of trench_ _ _ Type of filter material...S_ � epth of filter material__j_ _____________Total length----- �_-_-___-__--.-_______-_____.__ \ Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line-----.----------- 16 ❑ Number of pits---_------------------Lining material----------------------- 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--------------------------------------------------------------------------------------------------------------- C, Remode ingnd o�,*repa(ring (de ibe): ___-__;-- --- 'L"--- �� V + ----------------------------_---------------- �Q ------------------------------------------------------------------------------------------------------------------ -----------------------._ .------..-.------------------------------------------------ --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State law , and rules and re ulations of the San Joaquin Local Health District. (Signed)--)C t = ` ' (Owner and/or Contractor) -r------- By:-----/----------------------------------------------------------------------------------------------------------------------------(Title)---------------------------------------------------------------- (Plot plan, sh wing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY------------------------------------------------------------------------------------------------ DATE ------------------------------------------------- REVIEWED BY-------------------------------- -------------------------------------------------------------------------------- -------- DATE:::::-:::' W---------- _ BUILDING PERMIT ISSUED DATE----------- -------- ----------------- ----- ---- --- Alterations and/or recommendations:--------------------------- ----- ____ _ -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------ FINAL INSPECTION BYc---------------- ---•-- --- ------- Date.------------------ r ,�•/ ..- ,/ --------------(�' 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 ES-9-2M Revised 1-57 F-P.CO.