16031 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE- -------------------------------------------------------- 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 Ordinance No. 549. JOrADDRESS`ANP,LOC�TION .l t-PA 1 Owner's Name --:��-- -----r--------------------------------- -----•------••----------------------------------=----- - __.------------------=------------------ 't, Phone. ------------- Address ��- . ---- --- ---------- --------- --------------------------------------------------------------------••-•---------•-----•-•--•--------------------- Contractor's Name. ---------------------------------•-----------------------------.•---. Phone_._._- -D----- -----•---------- Installation will serve: Residence El Apartment House ❑ Commercial Trailer Court E] Motel E] #h�6 er ❑ Number of living units: __ Number of bedrooms _~_ Number of baths -------- Lot size - _ Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table j ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel 0 Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ r Previous Application Made: (If yes,date---- ------ -) No V New Construction: Yes No ❑ FHA/VA: Yes ❑ No;N TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted-if public sewer is available within 200 feet.) Septic T Distance from nearest well_________________Distance from foundation--------------------Material--------------------------------------------------- t No. of compartments--------------------------Size--------------------------------Liquid deptil--------------------------Capacity------------------- ` Disposal le - Distance from nearest well._ -_____Distance from foundation..s-. Distance to nearest lot Iinp___. __0_..__. Number of lines.___.______._._- Length of each line_ '�Q___-____r�__._._.Width of trench-- ______________________ yi Type of filter material_ Depth of filter material----1e---'1F------Total length_____.5_,Z�__________________________ Seepage Pit: Distance to nearest well._10_ ``______Distance from ou ti n__4.0_.._____Di to ii? to nearest 1 # 'ne------ _ ..1 Number of pits------ -----------Lining material__- iameter----- -- ---Depth_-.-1.- ----------:---------is Cesspool: Distance from nearest well_________________Distance from oundation--------------------Lining material---,---------------------------------- i . ❑ Size: Diameter-----------•--------------------------Depth--- ----------------------------------------- ------Liquid Capacity---------••-•------------ gals. -..� ._� Privy: Distance from nearest,weli____ _--------------------______-____-----Distance from nearest building--------------------------------- ______._. ❑ Distance to nearesf'lot line------------------------------------------------ -•----------------------------------•----------------------------- --------- -------------- �Q Remodeling and/or repairing (describe):-- --------- -------------------------------------•-•-----------------------•-----------`------------------------•----------------------------- • '-----••-------------------------- ---•------------------------------------------------------------------------------------- ------------------------------------------------------------------------ r . yt ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State aws, and rules and regulations of the San Joaquin Local Health District. " (Signed)--- ------- --=r- ---------- ------------------------------------------ -------- - ------.(Owner and/or Contractor) y BY:....------------------------------------------------------------------------------------------------------------------------------(Title)---------------- ---------------------------------------------- (Piot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side).' FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------ -----------------------------------------------------p--------------------- DATE --- BUILDING EWED BY-------------------------------------------------------------- ------------ DATE �-- - � � to BUILDING PERMIT ISSUED --------------- --------- DATE------------------------------ ------------ Alterations and/or recommendations----------------=------------------- -------------•--...-..--------------------------------------------------------------------------------------------------- ----•---------------------------------------------•-•------------=----------------------------------------------------------------•--------------- ------------ ---------•------------------------------------- --------- ------------------------- ------------------•---------------------------------.------------------------------- ----------------------------------- --- ---------------------------------- ------------ -- ------------------1--------------------------------- ---- ---- 3 FINAL INSPECTION BY:. ------- ---- - Date_ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haielton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stocktonr California Lodi,California Manteca,California Tracy,California ES 9 REVISED 9-54 3M 3-'63 F.P.CO.