12488 - Laserfiche WebLink

Home Browse Search

,APPLICATION FOR SANITATION PERMIT Permit No. .. f,f (Complete in Duplicate) Date Issued ------!- `1 0 This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local'HealM 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,—.-CATIO, = 4 -_ .:_ ..,.. w ' L � ' . Owner's Name-------- Phone----------------- -•---------••---- J ---------A114.r �`�-�- --•-----------------------------------•-•-----•-------------------------------- Address--------------- ��..� - --- -••-------------------- Contractor's Name__ �i�_��1 ----- _ --------------------------- Phone Installation will sere: Residence; Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ other ❑ Number of Iliving units: /--- Number of bedrooms ---<_ Number of baths _-/----- Lot size ___�--_ -�___________________ Water Supply: Pubiicsystem E]bUlt-4 ommunity system ❑ Private Depth to WaterTable .- - ft. Character of soil to a 'depth of 3 Sand ❑ Gravel ❑ Sandy Loam [❑ Clay Loam ❑w Cla) ❑ Adobe Hardpan ❑ Previous Application Made: Yes No,[] New Construction: Yes R1 No ❑ FHA j,A: Yes ❑ No g �' 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--/ :.__.._..Materi a------��-f&._ _ __----. No. of compartrjentsa.-=- _,,�_::-- Size---_- . '_ - = -- Liquid-dein#h-:----= --------CapacitY----, ------ Dispasai Field: �istance from nearest well-,----J"a._S�Distance from foundation_ �_�,__...___.,Distance to nearest lot line.--5-- __:_..- Number of lines---r_/_______ ._ Length of each line.........__7____�S_.Width of trench_______ �___.____ Type of filter mai Depth of filter material____.f-. 1 Total length________��_____ �----------- y' _----__-- VV I :-. Seepage Pit: Distance to nearest well_ _-_-_.__.__Distance f�r� fa dation-----�d---_l.Distance toy Barest lot line--f--i�-_.-._.- d Number of pits____f ---_ m Lining aterial-___ _ z _Size: Diameter -_ ..�-?-Depth__________ ________________ Cesspool: Distance from nearest well_______L-_1 'Distance from foundation---------------..__Lining material_________________.__________________- r ❑ Size: Diameter- -�-------------------------1-----Depth---------------------- ----- ---------------------Liquid Capacity------------- -- ----gals. " Privy: Distance from nearest well___________ -----------------------------------.Distance from nearest building------------------- Distanceto nearest lot line.-------- ----------------------------------------------••----------------------------------------------------------------------- --------- Remodelingand/or repairing (descriSe)------------------- ------------------------------------------------------------------------------------------.----•---------------------------------- a i ------------------------------i----- ---------------------------------------------------------------------- i --------------------- --------------------------- - ----- ----------------------- ------------------------------------------------------------------------------------------------------------------------------------------- 1 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 ti regulaons of he San Joaquin Local Health District. (Signed) �,�r � ----- �� - - =--------------=------------------------------ ----------------------(Owner and/or Contractor) �. - ----- - Title ----------------- (Plot plan, showinj size of lot, location of system in relation to-wells,.buildings, etc., can be placed on reverse side). y FOR DEPARTMENT USE ONLY• 1 x DAA;E- -� --" APPLICATION ATCEPTED BY_..-____-]_.._- r j REVIEWED BY ro� ) i- --- DATE r1 - ' BUILDING PERMITSUED----------------- ------- -------------------------- - DATE Alterations and/or recommendations: �� -~-T-- -�`-----------'-•--^�~~��^^ � -----� -------7 --•---------- ---------------- -----=-------------------------•----------({/J'/�t-- •---------4:;-------------------------------------------------- ------------- ----------- �(^ - ------ ------ --- --- ' -..._ G -�'------ ----�4- --- ------- -- ----------- ---- ------- ------ - -- - - -------- - �' --•--------- -------------------------------------- FINAL INSPECTION BY---------------------- �----------- --------- Date 4L -- ----- -------------- --- -- ------ ------------- 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-92M Revised 8-'59 F.P.Co.