10108 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) 9 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 .LOCATION ' --'� (-------- r -----------------1 /---17------------------------------ ---------------- ------•---•------------ Owner's Name- --- -- ---------- = - ------------------ ------------_------------ -------- :_-- Phone------------------------ ------------ Address-- ------_:------ ------- Address.- - f ---------••-------------------------------------------------------------------------------- r } Contractor's Name--------W �/- 4f --A — ----------------------------------------- ------ Phone----------•-----•--- Installation will serve: Residence artment Housemercial [❑ Trailer"Court ❑ Motel ❑ Other ❑ • , Number of living units:/______ ber of bedrooms __ . Number of baths/-----.Lot size --------------------- Water Supply: Public system T, Community system '❑ Private•❑"Depth to Water Table __._.,: ft.--. Character of soil-to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam.❑ Clay Loam ❑ Clay ❑ Adobelardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes to ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: r (No septic tank or'cesspool permitted if public sewer is available within 200 flet.) Septic T Distance from nearest weft � _Distant from oundation___________________Material___} __ ____ _ ----------- NLY0 -compartments__ -------- - Size__ ' __ -__Liquid depth �.. --- --___-.Capacity_--- � Disposa field Distance from Weare t well---------- t Distance tram foundation_ �U :Distance to nearest lot-��e___ `J Number,of lin es---_- -----. Length of each line___ ____ Wid#h'.of,trench_. =! --------- _ _______ ___ �}J 'Type of filter mate'rial-Z pfd g r De th of filter mater a!____ _____ _______Total length � ___ _•- t Seep' Pith Dis'tance to nearest well___=_ _Distane• om ur'datian_ _�_J___� Distance to nearest lot li`e._:?_________:._ Ksi+�–!r " Number of pits Lining ing __ Size: e _ Depth- l Cesspool: *;: .`Distance from nearest well___`'=_'_'____°_Distance from foundation-----________'_:____Lining material--.---------------------------------- . Size: Diameter---------------------------t _ th- -------------------- -----___Liquid Capacity ❑ - De p .-----------.------------ q ----------------------------gals. Privy'. ° Distance from nearest well_'._ _____ ___________ _ __ ___ Distance from nearest building___-_ ------------------------ __._. ❑ ----------------- Remodeling- ------ rt �� crest lot�lme ` = __ w �, _. -"_- ----- Remodelin -and or repairingfitod sf � -------------------------- ------------------------------------------------------ --- ------- ------------------------------- ----------------------------- --------- ---------- ------------------------------------- ------------------------------------------------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County es ad regulations of the San Joaquin Local Health District. 4 ordinances, State laws, an rules n `� l _ Owner and/or Contractor (Signed) - _ ( Plan, showing size'( -------------------------------------------m------------------------------------------------------ ------------(Title)-------------------- ------•---- --------- ---- ------ Plot of lot, location of s ste --in, relation to wells, buildings, etc., can be placed on reverse side). 1 i l_. -'FOR DEPARTMENT USE ONLY 1 APPLICATION ACCEPTED BY---- -------------- ----- -------------- ---------------------------------------- DATE---------------------- - --------------- REVIEWED BY = = '=: - DATE /� ----- --- BUILDING PERMIT ISSUED---------- '------------ ----- -----------------------------------------------• DATE----- I- ----------------------------------- ns: ----------------- ------------ ; �.. 't ; ,A, Alterations and/or recommendations: - -------------------------------------------: - -- ---------------------------------•--•------------- f. ______ _-------k----------- ------ ----------- ___________ , ___ _________ - f_.__ -.____.__"_____________________ ------ --------- ----------'- - -------- ------- -----_ FINAL-INSPECTION BY:.- - = -=---------- Date = = = _ ---------- SAN JOAQUIN LOC 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-9-2M Revised 1-57 F.P.CO. f