12378 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT ` •r / .'fermi+ No. -�••--•-3--7.---- (Complete in Duplicate) This Permit Expires 1 Year From Date Issued 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'wii��th County Ordpc�inaN . 549. F ) JOB ADDRESS AND ATlON . t Owner's Name = Phone--•-•-------------------•------•---- p Address �1_�GP ---------------------------------- r-----••--•-•-------------••----------••--•--- I Contractor's Name ---- -----------------------------•----------- ---------------------------------------- --- Phone------••--------------------------- f Installation will serve: Residence [,Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel n Other ❑ Number of living units: _._f Number of bedrooms _--L_-'Number of baths __4--- Lot size --_...______ ---- d Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table VZft. 3 Character of soil to a depth of 3 feet:r Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No E/&—New Construction: Yes ❑ No [ FHA/VA: Yes ❑ -_No-1 ' r TYPE OF INSTALLATION AND SPE81FICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest ` a�est well_____._.____.____Distance from foundation__.______________.Material-__-..___.+.___.__..___.________..___.___.___.. No. of compartmeI ts--------------------------Size------••-------•----------------Liquid depth--------------------------Capacity------ -------------- 10, spos Field: Distance from neatest well___'' `'"..._Distance from foundation.-LV- to nearest lot,line--to---------- Number --_---- 11Lengthfi , Type p - .Width of trench. •�� Nue of filter material_ �fi_Depth off filter h mlater�al_._. �._ _____Total• kength_._.__' Q___________________________ \ J Seepage Pit: Distance to nearest well------~'-7__.----Distance from fouffdation___!��__.___.Distance to line_ _%' lot iine %lY____.._ El Number of pits----- -------------Lining material.__/f%P0'__AA .Size: Diamete�'_t_ -----Depth------o-Z y---___--_-_-_-- Cesspool: Distance from nearest well-----------------Distance from foundation---_-_-- .s.-.-.Lining material-_.-_--------------_.----.-.--_---_--. Size: Diameter--------------------------------------De th---_------------------ _......__._....Li Liquid Capacity ❑ p -------------- q ------------------------•---gals. Privy: Distance from nearest well----_.__________________________________-------Distance from nearest building------------------------------------ ElDistanceto nearesft lot line--------------------------------- --- --- - ---------------------•- -------------------------------------------------------------------- Remodeling and/or repairing (describe):----------I----------- ------------------------------------------------------------- I ---------- ------------------------------- - - ---------- i yT ----- ----------------•----•------------------------------------------------•---------•-----••---------------------------------------------•-------- 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 egulations of the San Joaquin Local Health District. K (Signed)------ ----- -- -----------/L-�— -- - ------- -------- --------------------------=----------------------------------------�r Contractor) 4�1 By----------------------------------------------- - - ------ ---------- = (Title)----- � ��— -- ------ ------- ---------------- (Plot plan, showing size of lot, locati f system in relation to wells, buildings, etc., can be placed on reverse side). I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-----------` --------- ------------- ---------------------------------------- DATE--- a REVIEWED BY--------------------------------------- QATE BUILDING PERMIT ISSUED-----------------t------------------------------------------------------------------------------------ DATE---------------------------------------------- Alterations and/or recommendations:t, I! A --------------------------------------------------•---••-.----- ----------------------------------•-----•--------•----------•--------- -------------------------------------------------------------------------------------- it --------------------------------------------------------------- ---------------------------------------------------------------------------------- ------------------------------------ ------------------------------------- ------ --------- --------- ------- - -------------------------------------------- ---------------------- ------------------------------ J ' . FINAL INSPECTION BY--------- - -- ---- ---------- --------- Date---------�--_.-.?, .6� SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oafs Street.. ' \132 Sycamore Street � ., 814 North "C" Street Stockton, California Lodi, California Manteca, CSlifornias t Tracy, California FS-9-2M Revised 9-'59