15520 - Laserfiche WebLink

Home Browse Search

FOR OFA USE: F,e•A-PPL,ICATION FOR SANITATION PERMIT Permit No. - ------------ --- ------------ ----- (Complete in Duplicate) / ------ This Permit Expires 1 Year From Date Issued Date Issued ______ --.----- _._._ . - I 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 - - ---•---••---••-•---•--------------.................... Owner's Name--------- --`-- -•-•------------------------------------------ --------------------------------- ... Phone..--------------•--••------------- Address......... Contractor's Name---------- __--S_7S. .................... Phone.................................... Installation will serve: Residence Ell', Apartment House ❑ Commercial L] Trailer Court ❑ Motel ❑ Other ❑ , Number of living units: .1------ Number of bedrooms 3.... Number of baths .1:.__. Lot size ___--------------------------� 1 ...... .. Water Supply: Public system Community system ❑ Private ❑ Depth ro Water Table `U. ft. r Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy loam ❑ Clay Loam ❑ Clay ❑ Adobe(g Hardpan ❑ Previous Application Made: (If yes,date____________________) No [ New onstruction: Yes 'f No C] FHA/VA: Yes E] No �— TYPE OF INSTALLATION AND SPECIFICATIONS: N •. (No septi tank or cesspool permitted if public sewer is available within 200 feet.) Septic I Distance from nearest well------------------Distance from foundation--------------------Material -----• •---..............----------- I El No. of comOrtm�nts----------------_----.--Size-----------i--------------------Liquid depth--------------------------Capacity----•------------------ p Dis os I Fi r1�: Distance from nearest well___---'------Distance from foundation_ Distance to nearest lot line......[ � vr Number of lines__t---/-_____________________-_-Length of each line_. �} `_ __ Width of trench-_ --------------------- ; -- r i 4 !Type of filter material ._ �_ �_� oC� . ______Depth of-filter material___f III-------------- length------oZa--------------- Seepage Pit.- Distance to nearest well-----___________Distance from foundation_..•p_r.__..D-i:stance to nearest lot line:_.`��_�___- Q ''' Number of pits------j______________Lining material f-- _.--Size: Diameter_ _-_._..-_.-__Depth--.__.Z.s............... j Cesspool: Distance from nearest well-----------------Distance from foundation-------------------Lining material---_---------------.-______._________ € ❑ Size. Diameter--------------------------------------Depth----•-----------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest wall----------------------------_-------------_-----Distance from nearest building____________________-___-_-__________.._. ❑ Distance to nearest lot line------------------------------------------------------------------........----------------------•-------------------------------------------- Remodeling and/or repairing (describe):_____________________________ __ ° 1 -----------------------------•-----•-------•--•--................----------- s - ---------------- ---------------------•-----------•---------------------------------------------•---------------------------------------------------------------------------------------------------------- I 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 regul� ans the Sa Joaquin Local Health District. (Signed) ___.________Owner and/or Contractor L ) By:.....................-----••---------- ---- ------- --- ------- ---------;----------------------------------------------------(Title)----------------------------------------.--- - ----------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). OR DEPARTMENT USE ONLY S APPLICATION ACCEPTED BY------- — ---------------------------------------------------- DATE....- . ...4_-_.6 REVIEWED BY-------------------------- -------------- --- -------------------------------------------------- ------------------------------ DATE----- ----------------------------------------- - - - BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations:-----=------------ --- ---------------------------------•--------- -----------•------_.--------- ------- ------------------------ j 'X -----•----•.......................... ------------------------------------- ---------------------------------------------- ------------------------- --------------------------------------------------------------------------------------------------------------- FINAL INSPECTION BY:..........- -- -'_, ------------------ Date--------_-- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED a-99 2M 5-62 ATLAS j