12289 - Laserfiche WebLink

Home Browse Search

APPLICATION -FOR' SANITATION PERMIT Permit No. .( .? lComplefe 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 insFall the work herein described. Th's application is made in compliance with County Ordinance No. 549. ' -. " ._�-.-., JOB ADDRESS AND' L@ATION_______r _ rr ------- Owner's Name----------- -------------- Phone IAddress------------------•---------- 41�--•------------------------------------------------------------------------------------------------ Contractor's Name----------------- -------------------------------------------------------------------------•-------- -------------------------------------------- Phone..------... Installation will serve: Residence ❑ Apartment House Commercial W G ,&ed/ ❑ ❑ Trailer Court ❑ otel ❑ Other+ T/ Number of living units: -------- Number of bedrooms -------- Number of baths -------- .Lot size ____ _ --->-------•----------- Water Supply: Public system Q Community system ❑ Private IX Depth to Water Table ff. Character of soil to a depth of 3 feet: I Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeL-K-L Hardpan ❑ Previous Application Made: Yes p No)!'J, New Construction: Yes ❑ No [- FHA/VA: Yes ❑ No' �. TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public ewer is available within 200 feet.) Sepfiigc Tank: Distance from nearest welL4�------Distan e fr M f ndation---- No. of compartments-_4Z------------- -Size_ ----_ Liquid dep}h--- ------------._.Capacity_-_,� ------_ r�~/ T� f DispoIal Field: Distance from nearest well--- .....Distance from foundati _, -"______.Distance to nearest lot line.__--_---- 1� Number of lines * __..�, -_--.-----_ Length of each line___? Width of trench. ` Type of filter material_r� _----_ �� ------------------------- YP Depth of filter materia! __ -___-------Total length-__--- ?- . r f Seepage Pit: Distance to nearest..well----------------------Distance from rfoundation----_------------Distance to nearest lot line----- ---------- ❑ Number of pits. ----.---. Liming material-----------------------Size: Diameter----------------------Depth... ------------------------------ esspool: Distance fromnearest well_"__'_ .-Distance from foundation_-------------------Lining material------__________,_--_--_ ❑ Size: Diameter----------------- ----------------Depth------------- ----- r ------------------------------Liquid Capacity------------i-------------=-gals. Privy: Distance from nearest well-_..___---____-._ tee_ -------------------------------Distance from nearest building--------------------------•- Distance to nearest lot line ------ ._ r- Remodeling and/or re firing {describe):--------�-------, ------ .�.�✓� ' ;-_Y_ --- -------------- ----------------------•-------------- ---------------------------- --------- --- -- ---- -= -------- - --- - - - ---- I hereby certify that f have epared.this application and that f e ork will be done in accordance with San Joaquin County ordinances, State laws, and rules and r ulationsof the San Joaquin ocal Health District. (Signed)-- - -=------------ ------- ,-- -�--a �------� -----------------------------------(Owner and/or ContractorBy:-------------------------•------------- _ ifle-- - - ------ ----- ------------- ) ,;{ T ot plan, showing size of lot, location of system in relation to wells, buildings, etc., can :be placed on reverse side). _ I FOR DEPARTMENT USE ONLY 1 APPLICATION ACCEPTED BY---------- --- ------ --- --- -----------/------- - DATE REVIEWED BY BUILDING - DATE---- --PERMIT ISSUED ----- ----- I ----------------------------- ------------ ---- --- ----- ---------- --------- DATE----- Alterations and/or recommendations_ ----- ------------------`-- ----------- --- ------------------------------ / ' ---- '�r�---- -------=- . - ��----- --..4------------- ---------------------------- ------------ _. ' -------------- -------------- -------- - FINAL INSPECTION BY:___ _ __._ Date__....-_ -: .Odle 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-9-2M Revised 8-'59 F.P_Co. � xb