11172 - Laserfiche WebLink

Home Browse Search

� �1 APPLICATION FOR SANITATION PERMIT Permit No. _•-/-,l/..7z (Complete in Duplicate) Date Issued ._._. ��"�� Application is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein descr' ed. This application is made in compliance with County Ordinance No. 549. / `� JOB ADDRESS AND .LOCATION— ------------------- -sr'e`---"---(tet-04..---X-`(3-^�(-�----- l `u ---- ------------ Owner's Name -�c ------------------------ ----------------------. P one----- ------ Address------- --=------------------------------------------------------------------------------------------------------ - -- --------- Contractor's Nam --�� ---- ----------------------- --------------- Phon Installation will serve: Residencee- *Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: f------ Number of bedrooms _A�__ Number of baths ---/-. Lot size --- --------------------- Water -__________________Water Supply: Public system ❑ Community system ❑ PrivateDepth to Water Table -------- 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: Yes No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if publ' sewer is available within 200 fe t. tt \_ / Septic Distance from nearest well_ : ____Distance from foundation---[_ ___------Material-_:___ _________-___._- %/_�,,� No. of com artments 0 e _ -�_�`_ f� p 1z--------------_-_Size_ Liquid depth_._ g___________Capacity. �---____-- r � 3 A r I Disposal Fi Id: Distance from nea .est well_`.D____._Distance rom foundation ------Distance to nearest lot line-----•�__... Number of lines__i________________ __ _______Length of each line:-----{ 0_�_ _ _____-Width of trench----- ---___-______-_. Type of filter material_,__- tC_1__.Depth of filter material____E-g-'[---------Total length____-__-_s��_---------------------- Seepage Pit: Distance to nearest well----------------------Distance 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) ------------------------------•------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I 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, q (Signed)--� `---- ------------- -- ------- --- • --------------------------------------------- Contractor) gY: (Title)--------------------------------------------------------------- (Plot plan, showing size of lot, location of system in relatio wells, buildin etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED �------------------------------------------------------------------------- DATE-------- -,0-�------------------------------ REVIEWEDBY•----------------------------------------- - ---------------------------------------------------------•-•------------=------ DATE------------------------ --------------------------- BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------------- ------ DATE------------------------------------------------------------- Alterations and/or recommendations-----------------------------------------------------------------------------------------------------------------------------•------------------------------ -------------------•--------•--------------------------------- ---------- ------- ------------------------------------------------------------------------------------------------------------------------------------------ ----------------- ----- --------- -- - ------- ----- - FINAL INSPECTION BY---------- ----------- --------------- ------- -- - ---- . Date---- -- - ----- -------------------------- 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 Revisea 1.57 F.P.CO.