11853 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. .../..........:....... (Complete in Duplicate) Date Issue d�l._�/�•• This Permit Expires 1 Year From Date Issued C 33—old —02 Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein d ibe� rl� This application is made in compliance wit County Ordinance No. 549. t �+-� - JOB ADDRESS AND LOCATION__ �__.1/� - e'A( --------- . � . fir Phone ------ Owner's Name_________ _ Address---------------------- ------- --------••------ -------- Phone Contractor's Name__________."___.______" --- G� Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ®� Number of living units: -------- Number of bedrooms ------ - Number of baths ________ Lot size __.___�_v__-/-________--._ I Water Supply: Public system [Community system El Private F1 Depth to Water Table /.t�__ 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 ❑ No e FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) UQ ___Distance. rom foundation_---L�--____.Mate)ai__-_ _ -- ----1G--p-�� -- Septic T k: Distance from nearest well _ Capacity--- ... a -�p------• Sizeq p No. of compartments--- - -- - -y -Li Liquid de th ---------- � "F�___.Distance to nearest lot line____��_ -- Disposal Field-. Distance from nearest ll.__._' '._Distance from foundation=_`-___ f__ fr Number of line s__.___"" "_ __._ ._---."Langth of each line__ L�--. - Width of trench__ ------------- Type of filter material--- .6 Depth of filter material___ ��------Total le Seepage """-------------• C3 Seepage Pit: Distance to nearest well---------. '__--___Distance from foundation___________________.Distance to nearest lot line_.___________.. � Number of its----- - ----Lining material--------------"--------Size: Diameter-----------------------Depth----- --------- ❑ p Cesspool: Distance -Vm, nearest well-----------------Distance from foundation_________".____.__- Lining material__.____._----___ ---__________ ❑ Size: Diameter------------------- --------------Depth-------------------------------------------------- Liquid Capacity gals. _________Distance from nearest building ^' Privy: Distance from nearest well------------- ----------------- - - ------------ t� ❑ Distance to nearest lot line.-.---.----- - ------ -- ----------- ---------- ------------ ----------------- --- - -----------"- - - a ,-= ------ R --)4 emodeling an or re airing (describe)------------- -------------- ------------- ------------ -------------- I hereby certify that I have prepared +his application and that +he work will be done in accordance with San Joaquin County ordinances, State laws, nd rules and re uiations of the San Joaquin Local Health District. Az? r Contract - r� -------------------------------------- (Signed)---- -- ---- - -- - --- Y:---------------••-----•---------------------------- , etc., can be placed on reverse side). (Plot plan, showing size of lot, loca+ion o min relation to wells, buildingsz j FOR DEPARTMENT USE ONLY I APPLICATION ACCEPTED BY--"-- ---1-- ----------r --- DATE-------- ± ----------------------- REVIEWED BY------------------------------•------ ------- ------------"-------------------------- --- DATE----------------------------------------=-- ---- ------ DATE----------------- ---------------------------------------- BUILDINGPERMIT ISSUED-------------------------------------------------------------- Alterations and/or recommendations:---------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------- ldirF ------------------ --•---------------------------------•------ ------------------------------ -- ------------- ------------- -----"------------ ------- -------- r --------- -- ---------------------------------------- --------------------------------------"-------------------------F1NAL INSPECTI®. BY --- ------- Date.. 4-60 --------------•---" } SAN JOAQl11N LOCAL HEALTH DISTRICT. } % V r '1 1`4..# +i 814 North "G" Street 130 South American Street ;300 West Oak Street 132 Sycamore Street r Y t Manteca, California Tracy, California Stockton, California ^ Lodi.I`6alifornia F5.9—2AA Revised 0-'59 F.P.Co.