19256 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ._�..L.. _.. -------- ---------------------------------- ------ ------ (Complete in Duplicate) t� Date Issued --. _ .--_----- . ..__ This Permit Expires 1 Year From 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. x ! JOB ADDRESS AN OCATION_X -_-- ---_2�.l✓? r Owner's Name --------•------ -------------- - Phone--------------------------------•--- Address__--__ -x�G�% ` r _ ------- --------•------------------------------ Contractor's Name.-. _ - K`----- Phone Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __._ _ Number of bedrooms - ___ Number f baths __ Lot size _ ----- Water Supply: Public system ❑ Community system ❑ Private [Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay [Adobe❑ Hardpan ❑ Previous Application Made: (if yes,date--------------------) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic ank: Distance from nearest well-50?-------Distance from foundation-----«----.---Material-------1!t�- ------------------------ No, of compartments------ -------------- q p. p y- r}" Size Liquid de th Ca acct f 41 ;1G � r /V Dispos Field: Distance from nearest well._.. 11_..._Distance from foundation...�.U.___-----.Distance to nearest lot�lineJ-----.-----_. Number of lines--------- ------------------Length of each line-----ff}U-________.___.Width offrench---.�----.----_�._--_-_-.--_-- Type of filter material--_-_S./?- _-_-.Depth,of filter material-----L-_q/_-.r___.._Total length--------- 40-------------------- Seepa laic: Distance to nearest well ___./.VI_-------Distance from foundation-1.4_____________.Distance to nearest lot line______.__.-_ Q .� e ' Number of pits---------'Y.-_.---Lining material-----��?._�-------Size: Diameter------- Depth __________ Cesspool: Distance from nearest well--------------- Distance from foundation--------------------Lining material_-._._-----____-_-__--_-_--_-_------. ❑ Size: Diameter--------------------------------------Depth.---------------------------------------------------Liquid Capacity-.-------•--•---------------gals . G I ________________________Distance from nearest building-_------.---__._.---_-__-_ Privy: Distance from nearest well --------------- ❑ Distance to nearest lot line--------------------------------- ---------------------------------------------------•--------------------- ----------------------- s 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, qm4,,rules and regulations of the San Joaquin Local Health District. (Signed) _ ____________ _- --------- and/or Contractor w By:----------- = _ ' -- --------------- -------------•-(Title)---------------------------------------- -----------------. (Plot plan, showing of lot, location of sys+em in relation todtells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY DATE 1 f r.6_-S� ------------------------- REVIEWEDBY--------------------------------------------------- --------------- -------------------------------------------•-------------- DATE------------ ----------•------------------------------------ BUILDINGPERMIT ISSUED---------------------------------- ----------------------------------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations:---------------------. l -------------------------------- ---------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------- ------- •--------------------- ------ --------hh------------------------------------------------------------------ ---------- Date------------f- FINAL INSPECTION BY:- - ----•---- -------------- -----------------------..------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Haxellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Slocklon,California Lodi, California Manteca,California Tracy,California ES 9 REVISED 8-59 3M 3--63 F.P.CD.