12152 - Laserfiche WebLink

Home Browse Search

� C CY +$ APPLICATION FOR SANITATION PERMIT Permit No. .._ �z�...-__ .... (Complete in Duplicate) Date Issued ---- Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herei described. This application is made in compliance with County Ordinance No. 549. csf� JOB ADDRESS AND LOCATION�-.j_:A_J_._(- --------- 'J !_L'--------------`' �� it,�. '' Owner's Name_- 'pp- vet_�- -------------------------------- ----------------------------------------- Phone------------------------------- --- Addressl,.T' f-j------ - -------' --- - ------------------------------------------------------------------------------------------------------------------ Contractor's Name_ ------------------------------------- ---------------------------------------------------------------------- Phone--------------------------_----- Installation will serve: Residen [ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _1:____ Number of bedrooms _/___ Number of baths ----/. Lot size _,57.0__x-1 --_4---------------------------- Water Supply: Public system ❑ Community system E' Private ❑ Depth to Water Table X--- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay. Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No 2� New Construction: YesW No E] FHA/VA: Yes F1 No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) d Septic Tank: Distance from nearest well__6_44D---Dist an e�/fr m foun�on_____�_�7___-.__. at7rial___ No. of compartments_.-___"y'''__.-____Size�/�_�-X__GS._....Li uid de th_ _ _Ca acit .-_-B Disposal Field: Distance from nearest well---4__d;L47 Distance from foundation_____- y_.Distance to nearest lot line.._.�_S...... Number of lines----------- ---^ --------------_ Length of each line--- ....Width of trench._____„Z,__ __��_-________- Type of filter material____ 1__ epth of filter material-----�._�.__�-----Total length----&?, __________________ Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line----------------- Number of pits__________ __ Lining material-____-______________Size: Diameter;Z,_�_&_�4__ Depth____. __ _ _____--__._._______- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------------------------------- 0 _______-_____- ____________-__.--.❑ Size: Diameter--------------------------------------Depth---------------------------•------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-----------------------------------------------__Distance from nearest building------------------------------------------ F] Distance to nearest lot line--.-------------------------------------------------------------------- ---------------•-------------------------- Remodeling and repairing (describe):--- � -'- ----------------------------------------------------------------- ---------------------------------------------------------•----------•------------•--------------------------------------------------------------•-------•••-------------------------------------------------------------- O� --------------------------------------------------------------•---------------------------------------•----------------------------------------------------------------------------------•-------------------------- I - ----------------I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinan s; ate laws, and rule and r gulations of the San Joaquin Local Health District. (Signed). - - - - -----� ------ - -- - ------------------------------------------------------------------------(Owner and/or Contractor) -------•-- -•-------------------•------------------------------------------------(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 APPLICATION ACCEPTED BY---------------------------------------- ------------------------------------------------------- DATE--------------------------------- BUILDING PERMIT ISSUED-------------------------------------------- a DATE • ---REVIEWED BY---------------- -------------------------------------------------- - . DATE-------------------------------------------------- --y Alterationsand/or recommendations------------------------------------------------------_------ ------------------------------------------------------------------------------------------ ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------•------------------------------------------------------------------------------------------------------------------------•---------------------------------- --------------------------------------•--------•----------------------------------------------------------------------------------------------------------•--------------------------------------------------------- ----------- --------------------------------------------------------------------------------------------------------------- -------------------------------------/---------y----------------------- ------ FINAL INSPECTION BY----------------- - -=------ �- Date - �1- � �C 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 , Revises 1.57 F-P.CO.