13251 - Laserfiche WebLink

Home Browse Search

&/,/ /f,l /01 3v APPLICATION FOR SANITATION PERMIT Permit No. / (Complete in Duplicate) Date Issued .__.___ This Permit Expires 1 Year From 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 wi County Ordinan N�549. .�� ------- JOB ADDRESS AN LOC TION_____ _ ____ _ _ /1 Owner's Name----- ------- / ---------------- Phone---.-.----------------------------- ---------- Address----------------------------------- --- -- --------- -------------------------------------------•--------------- Contractor's Name --- _-- --- P h o n Installation will serve: Residence F] Apartment House ❑ Commercial ❑ Trailer Court E] Motel C] Other Number of living units: _______ Number of bedrooms ________ Number of baths ________ Lot size ____._____________________________________________________ Water Supply: Public system ❑ Community system ❑ Private [0""D�ipth to Water Table _3--- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ 'Sandy Loam ❑ Clay Loam [] Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes [B�o ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) _� Material V- .- -- - Septic TT k: Distance from nearest well_---------Distance from fo�ndati9f___ __ _____ __ _ No. of compartments_-___-_ ___Size_ ____.__ ____ �Sl©O -,�------- - 9 �l°- .�✓�__�-��Liquid depth-----�Sf----------------CapautY----=- ---------- -- r / .`� V Disposal Field: Distance from nearest welL_�-._____Distance from foundation____ O_______-Distance to nearest lot li Number of lines-------- ---------------- -----Length sof each line-----_--� --------------.Width of trench------q__.--------------------- 2--YA-11----------------- Type of filter materiaL__ � 0--------__Depth sof filter material _&'________-.-Total length___-_____ _y_.- - - r1 from foundation--------------------Distance to nearest lot line-----------------( Seepage Pit: Distance to nearest well----------------------Distance ❑ Number of pits---------------------Lining material----------------- -----Size: Diameter------------------ ---Depth_... --------------------------0 Cesspool: Distance from nearest well_________________Distance from foundation Lining material--------------.---------------------- ❑ Size: Diameter---------- ------------Depth------ -------------•-------------'----------- q id lCapacitY y gals.r -� -"`•-- '---- _Distance from -nearest.',building Privy: � Distance from nearest well______________________ '"�'""'=- ` ❑ Distance to nearest lot line-------h--------------------------------------------------------------------------------------------------------------------------------- -- Remodeling and/or repairing [describe}----------------- - ---------------------- -------------------•------- -------=----------------------------•----- --------------------•---------------------- ----------- I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinances.4tjt"wNanjd rules d regulatio s of the San oaquin L al Health District. i (Signed)-. ----- -- °---------- ��; Owner and/or Contractors 0 , i ------------------------------------------ Tale -- ------------------ ---- - ------------ (Plot plan;showing size of lot, ocation of system in relation to wells, buildings, etc., can be placed on reverse side). • FOR DEPARTMENT USE ONLY APPLICATION, ACCEPTED BY------- --" ---- -------------------- DATE --u �- _ - -&/------------------------ .REVIEWED BY----------------1--------------------------- ---------------- -------------------------------------------------------- • DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED----------------------------------------------- -------------••--------------------------------------- DATE--------------------------------------- --------------------- Alterationsand/or recommendations-------- -- ---- ------------------.---------------------------------------------------------------------------------------•------------------------------• R ----------- _______________________________________ _. I _ I ff C� `' ------------ Date......- ------ G` i ------------------------------------- FINAL INSPECTION BY:--------_`�.---=-��------ ----------- 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 FS-92M Revised 8-'59 F.P.Co. 4 A