11513 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. [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 with County lOrdinance No, 549. JOB ADDRESS AND LOCATION---------- Owner's ------ `Owner's Name------- A-• Phone---------- -------------------------------------------- Address--------------- ------------------------------- Address------------------ 1 -- Contractor's Name----------------------- - - Phone..___•--__-••--- - - ----------------------------------------------------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of livingunits: __- Number of bedrooms __Number of baths Lot size ------ ---------------------- Wafer Supply:Supply: Public system Community system ❑ Private ❑ Depth to Water Table �P/�`ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No ® New Construction: Yes 0 No [B-'--FHA/VA: Yes K4-- No 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___/P_f.__._Material___44�_4�te,-4e -----_- E4� No, of compartments_-___.e2_-_ __-__.-.-__Size_ __ __ _ ( '._-_Liquid depth___�� ---------Capacity—"a----• .. cif Disposal Field: Distance from nearest well__--.��_____Distance from founda`tion___ _� Distance to nearest lot line___ ` �� ----------- Number .Y Number of lines--------- . _Length of each line__---fes �,- -- - 9 -�-f-- d` Width of trench.--- -r'r------------ ---- Type of filter material--- Jf,,,/6Depth of filter material----.X ____Total length_--.--��9-:-- ---------------••---- t Seepage it: Distance to nearest well---Z--T �--___:_Distance fr m foundation__... __.Distance to neares# Number of pits------�-_--._._----Lining materiaL,/�e4/1e�-.Size: Diameter----��_��.--_Depth--____�?_-`�i4�C Cesspool: Distance from nearest well __1------------Distance from foundation--------------------Lining material------------------- __r___._ ❑ Size: Diameter-------------------------- ----------D-epth--------------------- -----------------------------Li Liquid Capacity------------------ - q P Y ---------gals. Privy: Distance from nearest well__________-------t----------------------_--------Distance from nearest building_____.-___----__________________..�___._. ❑ f Distance to nearest lot line -------------------------------------- Remodeling and/or repairing (describe):______________- '+ '- - - - - ----------------------------- ------------------------------------ ------------------------------------------------------------------ -•-------------------------•-------- -----------------------------------------------------------------------------------------------------------------•------------- -------------------------------------------------------- ---------------------------------------------------------------------------------------------•-------------•=--------------------------------------------•-------------------------------------- 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 regulations of the San Joaquin Local'Health District. , (Si ned 9 ) --------�-j%' ,r------------------------------------------------------------------(Owner and/or Contractor) By:----------------------------------------------- �Y �i :---`�----------------------------(Title)- )---.--.. _ '- --- ----- (Plot plan, showing size'-of lot, location of em in relafion to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------7TDATE 1r"-- - - --REVIEWED ---------------------------- BY------------------------------------------------------------------ -------------------------- ---------------------------- DATE-------------------•--------------------------------------- BUILDINGPERMIT ISSUED-------•-------------------------- -----------------------•--------------------------------- DATE------------------------------------ Altei*ations and/or recommendations:----------------------------------------------------------------------------------- - �.T. 7 PT+[5 ----7`ll_414K D --------- -- ��_�� r------ -----------I------------ ------------------------------------------------------- --------------------- ------ ------1 . FINAL INSPECTION--B�' r -- -------------- Date------- 1_f1----- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore $free* 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E5.9 2M Revised 8-'59 FY.Co.