19792 - 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. JOB ADDRESS AND LOCATION.� /f '-�-11" '-�/ - .c / Owner's Name_ ______.__ l _��J :. - ------ -------- --J---------------- --------------- // Phone ------------------= Address--------- r --------------------------•---•-------- ------------------------------ Contractor's Name-----------•___-- ------------- Phone..__....---_..... -•-- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ ther El Number of living units: __�____ Number of bedrooms ___��umber of baths ____I___ 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 p Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous•Applicafion 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.) Se tic Tank: Distance from nearest well------5'�)__Disfance from foundation____-_ _ -_Material_, f'_� _ No. of compartments____I --------------Size __-Liquid depth----�7__ _______________Capacity____ Disposal Field: Distance from nearest well-2-.0-----_Distance from foundation.20------Distance to nearest lot g - Width of french--Z-Z/i c Number of lines________________ ____.____ __Length of each line_________ __� Wi ` Type of fitter material_�7 Depth of filter material_______ _ _____Total length________ _ _ ---____ GC -- ----------------- Seepage Pit: Distance to nearest well----------------------Distance from foundation.-_..-..------------Distance to nearest lot line----------------- El Number of pits-----------------------Lining material-----------------------Size: Diameter---------------------- Depth--------------------------------- Cesspool-, Distance from nearest well-----------------Distance from foundation-------------------.Lining material....---------------------_-__________ ❑ Size: Diameter----------- ---------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest weli--------..------------------------ "-- _.___`Distaiice from nearest buildin w g- - -------------------------------- Distance ----- ---y----�.------ ❑ Distance to nearest lot line----------- ------- --- Remodeling -Remodeling and/or repairing (describe):-------------------------------------------------------------------------------------------- --•-------------------------------------------------•-------- -----------------------------•--•----------------------------•----------------•-----------1---------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------- ---------- 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. ------ -------------- ------- ------- ------------(Owner and/or Contractor) By:-------------------------------------------------------------------------------------- --------------------------------------- -----(Title)---------------------------- - --------...--- ------ (Plot plan, showing size of lot, location of system in relation to wells, buildings, efc., can be placed on reverse side). FOR DEPARTMENT'USE ONLY APPLICATION ACCEPTED BY--------------- ----- --- ---------------------------------------- - DATE--- - REVIEWED BY ------ -- ----------------------- ,I .�� DATE - - BUILDINGPERMIT ISSUED--------- ----------------------------------------------------------------------------------------- DATE---------------------------- ------------------------------- Alterations and/or recommendations---------------- --------------------------------------------•----------------------------------------.-_------- --------------------------••------------------------•----------------------•------------ ------=----------------------------------------------- -------------------------------------------------------------------•---------- ----------------------------------------------------------------------- --------- --------------------------------------------------------------------•------------------------------ ------------------------------------- -----------------------------------•- --------•--------•------------------ ---------------------- ------- -------------------------------------------------------------------------------------------------------------------- ---•-------------- _- ---------------•- -------------------------------------- ----------------------------------------------------------- ------------------------------ FINAL INSPECTION BY .............Z---- -------/ Date.------------------ to Y ------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 west Oak Street 124 Sycamore Street 205 West 9th Street Stockton,Callfornla Lodi,California Manteca,California Tracy,California ES 9 REVISED 13-59 3M 3•'63 F.P=.