12663 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) This Permit Expires 1 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. This application is made in compliance with Cou tyyOOrdinance No. 549. JOBADDRESS AND LOCATION__��O -- ---------------------------------------------------------------------------------------------------- Owner's Name ,, , _/ _.. Phone.- ~1 Address-----------is- ----- �-r---- ---------------------------------- •------------------------------------------------------------------------------------•- Contractor's Name--- ---------------------------------••-------------------'-- --------------------------------------------------------------- Phone---------------------------------- Installation will serve: Residence q3 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ------ Number of bedrooms ________ Number of baths -------- Lot size ________I___________________________________________________ Water Supply: Public system 5( Community system ❑ Private ❑ Depth to Water Table ______ ft. 's Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Mader Yes ❑ No D4 New Construction: Yes jK No ❑ FHA/VA: Yes ❑ No ❑ 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_________________Distance from foundation--------------------Material---------------------------------------..-____._. ❑ No. of compartments--------------------------S;-e�Y- •------------_---Liquid de th-------------------- - -Capacity Disposal Field: Distance from nearest well__ " � _Distance from foundation___)-q-- 1 / _ ____.__Distance to nearest lot line_#!,J_______- Number of lines------p--------------- _______ Length of each line__ P----__________-_._.Width of trenrch.�r_�_�__-_.._______..__----_- Type of filter materia a> __�_ -Depth of filter material-_/.��___.__------Total length50: ________________________________ � Seepage Pit: Distance to nearest welt---------------------Distance from foundation--------------------Distance to nearest lot line--------------- Number ___.____.__ -Number of pits----------------------Lining material-----------------------Sze: Diameter-----------------------Depth----------------------------------- (A Cesspool: Distance from nearest well-----------------Distance from foundation. --------------------Lining material------------------------------------- (A ❑ Size: Diameter------ -------------------------------Depth--•----------------------------=--------------------Liquid Cap acity----------------------------gals, Privy: Distance from nearest well------------------------------------------------Distance from nearest building.----------------.-----------------------. ❑ Distance to nearest lot line------------------------------------------------------------------------------------•--------------------------------------------------- ��R----- !ti Remodeling and/or repairing {describe) ---- ---------------- - - •-��'_�"�-�'�t�'�-°�---------------------•---------=--------------------• ,I � r ------------•-- -------------------------------I----------------------- ------------------------------------------------------------- ----------------------------------------------------------- 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. r (Signed) (Owner and/or Contractor) ?jV (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- --I -- ------------------------------------------------------------ DATE-- ------------------------------ A. REVIEWEDBY-----------------------------------------------------------------------------------------------------•--•-------------------- DATE-----------•----------------------------------------------- BUILDINGPERMIT ISSUED----------------------------•---------------------------------—-------------------------------------- DATE------------------------------------------------------------ Alterationsand/or recommendations: -------- ------------------------.._..---- -------------------•------------------------•-•--- -•----------------------------------- ------- ---------------------- - ------------ ------ -- ---- --------- ----- --- - ----- -- ----' -----"---'-'--- __ r-- `----------------------- ----- ��- ----------------- -� --- ----- ------------------------------------------- ------------- ------------------ - -- - ----------------- ---�- - ; ,� - - FINALINSPECTION 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 Revised 8-'59 F.P.eo.