15120 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE '�..O ----------------- --------- YO --------------------------------------- ----------------- APPLICATION FOR SANITATION PERMIT Permit No. .. --------------------------------------------------------- (Complete in Duplicate) Date Issued .... Application _.__.._._._._----------------------__-._-_______.__ 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. 549. JOB ADDRESS AND LOCATION. �� X11 ------------------------------- -------�-t-_ ------------ Owner's Name._.- ....... ....... -• - to --------- --- ----------------------------- ;; Phone...................................... .............................................................. Contractor's Installation will serve: Residence//t artment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---!-•-- Number of bedrooms _;L Number of baths ____�. Lot size,�Ot __�(__.!_7..x_._7_��............. Water Supply: Public system ❑ Community system Of Private ❑ Depth To Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay W Adobe❑ Hardpan ❑ �(�N Previous Application Made: (if yes,date___-----------------) No V New Construction: Ye!)e No ❑ FHA/VA: Yes ❑ No� ,[ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) O Septic Tank: Distance from nearest well-----$Q_-_-Distanc from foundation----�_©_._......M trial____ ...........................� % No. of compartments-A------------ _ -----....Liquid de th__- _ Capacity... 10 oe Disposal Field: Distance from nearest, ell_---.- -__---Distance from foundation./Q.._... .. D-�, a to nearest lot li?e..... ......... Number of lines_.. T Length of each lines-I ��.2 Vwof trench./A� •- Type of filter material. ' Y .--.Depth of filter material----/ _-____-__--Total length___ f�!'.s ._______________________ Seepage Pit: Distance to nearest well---------------------- from foundation....................Distance to nearest lot line................. ❑ Number of pits----------------------Lining material-----------------------Size: 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--------------------------------------------- ----------------------•---------•---•-------•-••-•------•-••--•-•-•------•----....._.......----- Remodeling and/or repairing (describe):......................................................................................................................................................... •••- ----------------•-•--------------••-------------------------------------------------------------------------------------------------------------------------------------------•------------------------------------------- fi -------------------- ------- -• -- I hereby c t t have prepared this application and that the work will be done in accordance with San Joaquin County ordinanc at la I and regulations of the San Joaquin Local Health District. (Signed). -•-•---•------ ....... .......- ._.. ...- ----------------------------- ------(Owner and/or Contractor) By:......................................................... -------------------------------------------------------------------------(Title)------------------------------- --------- ---- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can-Ie placed on reverse side). - —- FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------------------------------------------------------------- ----- --------------- DATE----------•-------------------------------.........•-_..... REVIEWED BY---------------------------------------------------------------------------- - ------ --- --- - DATE---/j --------------- BUILDINGPERMIT ISSUED-------------------------------------------------------------- ------------ -- ------ DATE-----...---------------------------------------------------- Alterations and/or recommendations------------------------ ----------------------- ••-••------------ -----------------------------•-•------------•--------•-------•------------------------•------ ---------------------------------------------------------------------------- --------------------------------------------•------•--•--•-•-•-•----••--•--------------------------------•----------••-------------•----------. ------------------------------------ ------------------•----•------------- ---------......------------------......---•---•-------•------------...--•-----------------------•---_..._....--- ................................. ------------------------------ ....... ------------------ FINAL INSPECTION BY------ ------- --------------------------------------------- Date--------- - .......................... SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Stmt 124 Sycamore Street 205 West 9th Stmt Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8.59 2M 5-62 ATLAS —��