16201 - Laserfiche WebLink

Home Browse Search

FOR OFFICE VSE: APPLICATION FOR SANITATION PERMIT Permit No. .......V. ------------------------------ ----- --- (Complete in Duplicate) ________ _________ ______________________________________ This Permit Expires 1 Year From Date Issued Date issued ..-F '.__ Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the wodAerein described: This application is made in compliance with County Ordinance No. 549. t `. � JOB ADDRESS AND OCffAIIT ION ------------ -- -- - ------------------------- Owner's Name----- f '---------- ------ Phon S Address----------------------- ------ --------------------------------------------------------------------------- -•----------/---- q — Contractor's Name---- --------------------------- ----------- --- - ------------------------------------------•---------------------. a Installation will serve: Residence ❑ Apartment House ❑ Commercial X Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ________ Number of bedrooms -------- Number of baths _______ Lot size /D ___________________ Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table4/& ft. Character of soil to a depth of 3 fee+: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobex 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 200 feet.) p'F' A: Distance from nearest well_________________Distance from foundation--------------------Material-___.________________._____________..__________- No. of compartments--------------- ----------Size------------------------•-------Liquid deRth---------------- ....Capacity----------------------- i Disposal field: Distance from nearest well.. d___.._Distance from foundation._OR.�______.Distance to nearest lot Number of lines_________ _______ ---Length of each line--- --------Width of trench----- "y Type of filter material.,Z, _Depth of filter material__/---__------Total length________________�O_�___________._ r Seepage Pit: Distance to nearest well/�.6__________Distanc rom ff�undation_/_pR--0.___.Distanfe to nearest lot Number of pits.- -------------Lining material) .....__.Size: Diameter---Vk_______Depth_____e2t..__r____._________ Cesspool: Distance from nearest well--------------___Distance from foundation--------------------Lining material_________________________________..__. ❑ Size: Diameter--------------------------------------Depth---------------------------- ----- --------------- Liquid Capacity_-------------------------gals. Privy: Distance from nearest well---------_----r----------------------------------Distance from nearest building------------------------------------------ ❑ Distance to nearest lot line-------- ------------ -----_---------------------------------------- ---------------------------------------------------------------------- Remodeling and/or repairing (describe):------------------------------------------------------------------------------ t ------------------------------------ --------------------------------------•---------------------------------------------------------------------------------------------------------------•---------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St a laws, and r les and 4regfionis of the San Joaquin Local Health District. 4 (Signed)-------- -•---- -- - ----01.----- ------------------------------ ------- wrier and/or Contractor) - ------ ----- -------------- - - - - ---------- Title ----- (Plot plan, showing size of lot, Iota+ion of system in relation to weI , buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- ------------------------------ ---- )L ---- DATE------ r 7r ------------------- REVIEWED BY------------------------------------ ----------------- --------- ------ --- ------ ---------------•--- DATE------------------ ---- - ----------------------------------- BUILDINGPERMIT ISSUED-------------------------------- -------------------- -------—------------------ - ---------------• DATE---------------------------------------- -------------------- Alterations and/or recommendations------------- ------------------------------------------------------------------------------ -------•-•--------- ---------------------------- ---------------_ -------------------------------- --------------------------------------------------------------------------------------------------------•---------------------------------------------------•------------------------------- -----1--------- ----------------- ------------------------------- ----------------------------------------- --------------------------------------------------------------------------------------------------------------- ------------------------------- ------ - ------ ---------------------- ----- - ---------------------------------------------------------------• ------ ------------------------------------------------------------- FINAL INSPECTIONBY:- Date - ------ .... l_b ----------- — SAN JOAQUIN LOCAL HEALTH DISTRICT - 1601 E.Hazolton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REvi3Ea B-SS 3m 3-'63 F.P.CC.