9794 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR-;SANITATION PERMIT I! Permit No. (Complete in Duplicate) % 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 County Ordinance No. 549 JOB ADDRESS AND LON ----------- ------- ------ ------------ --- -- ---- - " Owner's Name---------Z- ------ - ,: Address , { - --------+ - -------------------------------------------------- -------'- - Contractor's Name_________ -' --• - -'- -- -- --- - -�- --- -- --F- --�`_----- -----•--•-----• Phon - f�--� -•- Installation will serve: Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units Number of bedrooms _jvi�Number of baths _/ Lot size Water Supply: Public syste m�eet: Communit y system E]em Private ❑ "Depth to Water Table—$ ft. " Character of soil to a depth Sand []'' Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ` Hardpan ❑ Previous Application Made: Yes [❑ No New Construction: Yes ❑ NFHA/VA; Yes D No ❑ TYPE OF INSTALLATION AND SPECIFfCATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) tie k: Distance from nearest well-----------------Distance from foundation_________________-�.Material.________._.__..__.___--- ----------------------- No. _. __No. of compartmenu--------------------------Size---------------------'----------Liquid depth-_*�-----------------------Capacity----------------------- Disposall F d: Distance from nearest well � Distance from foundation---/&_- _.Distance to nearest lot I-n�___�____-_--- Number of lines_______ ____________ ___ __ Length of each line__-___Q'______________.Width'of trench.-' ;r r - - --------------------- Type of filter material- Seepage of filter material____,/-S__`-__.Total length-_____2_,�1_ ------------------ Seepage Pit: Distance to nearest well 4 -_-Distance mfgandation__ _ _.Distance to nearest lot line______�__:_�. \' ®— Number of pits---- Lining materia_ _ _�_.�-...Size: Diameter- 3°--------Depth--- -f----------------- V Cesspool: Distance from nearesf well-----------------Distance from foundation-T--------------.Lining material----------------------------_.___--___ \ _ ❑ Size: Diameter------------------------- ------- - Depth-.--------------------------------------•- ---=Liquid Capacity----------------------- --gals. Privy: Distance from nearest well ___________~_r---__--------------_----_---- _._Distance Ifrom nearest. building__.__..___._________-____________._____- .❑ Distance to nearest lot-lire--------------------------------- ---------------------------- = = ,r {1 Remodeling and/or repairing (describe) =-------------------------•------------•-------- ------------- - ------1---------------------------------------------I------ U I here b ertify that I ve repared this application-land that the work will be done in accordance with San Joaquin County ordinances, S+ to is a ules and regul ions of + San Joaquin Local Health District. (Signed)---- ---- --- ------------- - ----------- -- --------- --- - -- - ------ ---------------- -------------------------1-- (Owner and/or Contractor) -- __{. �-- " title - By------------ -- --- - -- -- ---------- - ------------------------------( ) -----------------.. (Plot plan, showing size of lot, ocation of system in relatiq�i + wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ' APPLICATION ACCEPTED BY---------------------------------- ------------------------- ------- DATE------------ -----.= :�J REVIEWEDBY------------------------------------- ---------------------- ------ ---------------------•-------------------- DATE BUILDING PERMIT ISSUED--------------------------------------- ---------------------------------------- DATE------�- Jl j Altera�ns and/or recommendations------------------------- - :/ __.__..---_- ---------------------------•------ -------------------------------------------------------------------- - -- -------------------------------------------------------------------------- ----------------------------r---------------------- .- -: -- -------------------A----------------------- --- ----------------=------------------------------ -------------•--•--••-•----------•-•------------------------------------------------ Jr ------ -----------------------• •- ---- ----- : ---------------------------------------------------------------------------- -•-•-------• ------------------------------------------- ---------------•-------------- ---•---------------------- --------------------------------------------------------------------------------------------------•----------•-------- FINAL INSPECTION BY:-- = .� Date ' SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Strest 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M . Revised 1-57 F_P.CO.