12662 - Laserfiche WebLink

Home Browse Search

b V ZL Mt .., .! n APPLICATION FOR SANITATION PERMIT Permit.No. .--�oZ_ - __� (Complete in Duplicate) This Permit Expires I Year From Date Issued bate 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 A LOCAT101V "--- - -_----_- -' ,,Z . Owner's Name-- --------- .� f --- ------- ---------v Phone--------------- Address --------------- -- -- - .--�---_-.- .--•------------------- Contractor's Name--------- _ __X::__ L, -------------------------------------------------- f � •----•----------------- -- Phone--..--.._..----------------•- --- Installation will serve: Residence [X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _-'--.- Number of bedrooms 4. Number of baths _/ Lot size --- ------------ ----------------- Water Supply: Public system ❑ Community system ❑ Private Depth 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 V New Construction: Yes X No ❑,I FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: } ; (No septic tank or cesspool permitted if public sewer is available within 200,fee+.) # Se ti Tank: Distance from nearest well_-UP-----Distance from foundation- I_ ----Material No. of compartments------_ --------------_-size--- .1 _s__ __ Liquid depth------- ._f —Capacity-1 ------. Q ------------------- Disp sa# Field: Distance from nearest well___if-.-r�CS-.-Distance from foundation--..-_ � SC> Distance to nearest lot line _?e Number of lines-- ------- - --- -- --Length of each fin "__-:�'" 4 -- line, r.�- -.Width of trench--- r�__-..�--- ------------ Type of filter material__5� a�,Depth of filter material---1'�.............- Total length...... ----6b--------------------- Seepage en th---.- Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line-------------- ❑ Number of pits------------------ -Lining material--- f+-------------=�- Size: Diameter-- "----=------- ----Depth-------- ----------------------- Cesspool. Distance from nearest well--________----- Distance from foundation___________________Lining material__---..----_- _------_.----- .. Diameter. - -_ rDePth- ------------------------------------------_ Liquid Capacity--------------------- gals. �. . .� . Privy: Distance from nearest well-___---____------------------------ .--------------Distance from nearest building___.-.--__---._____ ❑ $` #Distance to nearest lot line-------=-------------------"------ r Remodeling and/or repairing (describe):---------------------- - x --------------------------------------------------------- ` -------•---------------•------------•-----•--•---------- --------------------------------------------------------------------------- -------------------•--------------------- ---- -------------------------------------------------------------- -----------------------------•-•------------------------------------------------•---------------------------------------------------------------------------- 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 +he San Joaquin Local Health District. AI (Signed)_-------__- __.-- -�(Owner and/or Contract ] ------- - -Z-2 ------------------------------------------- O � - orBy:--------- 00 - " __: ---- __---- - - Title (Plof plan, s owing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). r] FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED 8Y-. REVIEWED. BY --------------------------------------------------------------------------- DATE---------------------------- ----- -- ----------------------------------- DATE BUILDING PERMIT ISSUED----------- --- r-7- ----------- ----------------------- ---' _ Alterations and/or recommendations:-,_-_-.-___-__-- . � ----------------------------------------------------------------=-- - -------------------------------------------- ----- - --------•-•----------------------------------- ---------------------- FINAL INSPECTION BY:-_--...__--_ _ 9 n �..-�� Date - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 014 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-92M Revised 8-'59 F.P.Co.