18941 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: --------------------------------------------------------- APPEICATION FOR SANITATION PERMIT Permit No. . ��` ....... - ------ - ------ (Complete in Duplicate) Date Issued _ This Permit Year From Date Issued Application is hereby made to the San Joaquin Local Health Dict for a permit to construe't and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND - ° �, °'`a''g'✓ 'r ---------------------------------------------------------------------------•- Owner's Namee Phone Address......... `�''�a ----------------------- '"' - Contractor's Name---------------- ?!"''Ai ` '---------------- - ----- Phone----------- r -- - --------•--•------------------------ ------------------------------------ --------....--••------- Installation will serve: Residence ] Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms ________ 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: (If yes,date-----------__-------) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 204 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material______________.._____________-_-______-_________- ❑ No. of compartments--------------------------Size--------------------------------.Liquid depth--------------------------Capacity...--------------- -- Disposal Field: Distance from nearest well.476-------.__Distance from foundatiorn___.f�-4+_---------Distance to nearest lot line.--------------- �' �J Number of lines-------I--------------------- ----Length of each line-----x_.12---------------Width of trench_,X_Y_L------------------------ 1 T -__ Type of filter materia) z�,� Z.,.� Depth of filter material___-�--------------Total length---Zl:-Ct-----: ---------------------,- Seepage Pit: Distance to nearest well__. Q-------------Distance from foundation---1 '___._..Distance to nearest lot line_-f'__..•---.- O Number of pits___ ________________Lining material-,C��'�.______-Size: Diameter___13--__.__._____Depth__ .___________._______.__ P 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--------------------------e--------- -- ----------------------------••-•--•---------------- ----------------- ---------------------------------- Remodeling and/or repairing (describe):_A�4/ 14r a --------------------------------------------------------------------- �^ --------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -C --------------------------------------- -------------------------------------- ----------------------------•------------------------------------------------------------------------------------------------- -- 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. {S . __i ned --. _____________ ____________._ ______-__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 ACCEPTED BY �� ------------------------------------------------------------- DATE-- -_'-�" -r--------------------- REVIEWEDBY---------------------------------------------- --------------------- ------------------------------ DATE------------------------------------------- BUILDING PERMIT ISSUED------------------------------------------- ------------------------------------------------------ DATE------ ---------------------- Alterationsand/or recommendations------------------------ -------- ----------------•-----•--••--•--------•---•-------•-----------•---••------------------•-------•---•--------------------------- --------------------------------------------------------------•-- ------------ -------------------------------------------------------------------------------------------------------•------------ •------------------------ -------------------------------------------------------•-------- ---------------------------------------------------------------------------------- --------------------- ------------------------------------•--------------- ----------•------------------------------------------------------------- - -------- -----------•------------------------------- ------------------•------------------------------------------------------------------ FINAL INSPECTION BY:.___� r�P —--------------------- Date-- - �-.'.t --- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California CS 9 REVISED 9.59 3M 3-'63 i.RCD.