12635 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: -------------------------- I�—A�► APPLICATION FOR SANITATION PERMIT Permit No. -.2 ----------------------------------- -------------- --------------------------- ------ ----- ------ ------------------ -- (Complete in Duplicate) j s l _r. ___ _____ ____________________________ This Permit Expires l Year From Date Issued Date Issued ____ _._._._ Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. f This application is made in compliance with County Ordinagpe No. S49. 1 ----- ------- + JOS ADDRESS AND LOCATION... --------------- ------------------- - Phone------------------------------------ Owner's Name------- --------------------------------•-- dd e 2- ., . { Contractors Name___ `5 ----------------••-------------- l --' . _ . -------- - t . Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailei' Court-❑ Motel,., Other ❑ Number of living units: _ .._. Number of bedrooms _j----- Number of baths _l.____ Lot size _______________________________ Wafer Supply: Public system Community system ❑ Private ❑ Depth to Water Ta-b"le _ ft. Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay-' Adobe Uj—Hardpan ❑ Previous Application Made: (If yes,date--------------------) No [T" New Construction: Yes P'No ❑ FHA/VA: Yes ❑ No [?I— 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_z:no_--__Distance from foundation_0--------------Material___ No. of compartments----Z-----------------Size.......... �K67K!f---Liquid depth__._-----------------Capacity---- Pp . Disposal field: Distance from nearest well__--`--------Distance from foundation__ `_......__.Distance to nearest lot line.. Number of lines_____________/-_--____-___-__._.-_Length of each line.._._ ..--_......___.Width of trench___z '__,___----_-__._________ U Type of filter material---_� -F<------- of filter material----/$-_`'________Total length------*D----------------- ------------- 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------------------------------------------------------------------------I--------------------------------------------------------------------- Remodelingand/or repairing (describe):------------------ -------------------------------------------------------------------•---------------•.---------•------------------------------------ --------------------•--•----------------------------.. --------------------------------------------------------------------------•---•-------•-••--------------------------------•--------------•---------------•-------•-------•--•----------------•------------------------------- --------------------—---------- ------------------•--—---p---------------------------------------------------------•---------------------------- ------------------------------------------------- y I herebycertifythat I have re ared this a 'cat' n and fhat the work will be done in accordance with San Joaquin Count ordinances, State laws, and rules aVsf t e San Joa in 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 be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTEDBY - DATE----- -------------------------- REVIEWEDBY------------------------------------------------ --------------------------- ----------------------------------- ---- DATE..............••--------- BUILDINGPERMIT ISSUED------- ----•-------------------------------------------------_---------------- •-------------------- DATE------------------------------------- • - Alterationsand/or recommendations:--------------------- ------------------------------------------------------ ------------•--------•-----------------------------------•------------------- -- --------------------------- - --------------- - ---------- ----------------------- -�- -Z - - -- ----------- • --------- I 1 ---- Date----- f / FINAL INSPECTION BY: 4 �{^ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 305 West 9Th Street r Stockton,California Lodi,California Manteca,California Tracy,California EB-9 REVIBEC 9.59 F.P.CC.ZM 6.60 +