11891 - Laserfiche WebLink

Home Browse Search

1 APPLICATION FOR SANITATION PERMIT Permit No. ...11.... ..�_ (Complete in Duplicate) 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 cons#ruc n -'nstal1-the br`kiherein described. This Ordinance No. 549. l JOB „ -- -- B ADDRESS AND CAT ON_-- -- -_-- ------- --------- �r `/ - Phone_Name--------- - ��!r alt f - Address -------- �--------�� ------=------- f - Contractor's Name------------------ Gi --------------------------------- •------------------ 1 Pune I ---------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ M elI❑ Othe ❑ ' , Number of living units: _�_._ Number of bedrooms -- Number of baths --------- Lot size ____ .- - ------------------------ Water Supply: Public system ❑ Community system ❑ Private Depth to Watej Table -t ft. Character of soil to a depth of 3 feet Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan p Previous Application Made: Yes ❑ No kit__ New Construction: Yes L�L No ❑ _FH,A_1 A;_Yes_❑N'o 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 fr m foundation____�Q_._._._..Maerial---------------_ �_k._ ----- --- ; No. of compartments.....____ Size_ zle IS ° --------___Liquid de th._.__ _ Capacity__ .___;___.___ -- -`. ---�-------- ,---- Disposal Field: Distance from nearest welL_i�2.7V___ _..Distance from foundati . �_ _ /10--------- to nearest of line---.............. Number of Mines-__.____ _ I .--Length of each line----- � Width 'oo f trench. Type of filter material_ - pth of filter material_____I ------------ : fal_length----_ ------------------------- Seepage Pit: Dlisti nce TO-nearest well______-:-___.---_-_Distance from foundation-------------------.Distance to nearest lot line____-..-__----_ ----- Linin material-----------------------Size: Diameter-------1.1-------------- De th-.- -- -------------------------- [] Number1of pits_______________ -g Distance from foundation------------.-------Lining material------.-_.-__.----.._-----.--.--_-_-. t p ------------------- ---Liquid Capacity------------------ -------gals. ! Cesspool: Dis�ance from nearest wel!_�_ ❑�. Size:-•Diameter----------=----- �1---------------De th-------------------------- r. Privy: Distance from nearest well________________________________________________Distance from n�'arest building_-__.-.-..---.----��----____..._-___. ❑ Distance to nearest lot line------------------------- ------------------------------------------------------------------------------------------ ------------... Remodeling and/or- repo ing (descrihe):. ------------------------_T' --- -�- .�-� / ----------------------------------•-•- •--------------- # I -------------- ----------------------- --------------------- ---------- --------- ----------------- ----------- -------------------•------------------------------ --------------- w ---- --- ---------------------------- ---------------------------------------------------- ------ " 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 a_nd regulations of the San Joaquin Locai Nealth District. /f (Signed) r 41 , 7--------------------------- - {Owner and/or Contractor) -- - --- ---- t --� f �----------------------- Title --i (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc.,cen'6e placed on reverse side). , f FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY------- --------------------- -- ------------ ---------- ----------------------------------- DATE REVIEWED BY----=--------- I------------------------------------ — - ------------------------------------------- ---- DATE--- --- -------------------- BUILDINGPERMIT ISSUED-----------------I------------- . --------------------------- ------------- DATE------------------------------------ :----------------- --- I �c Alterations and/or recommendations:._. --------------.---------..----------S--------` I - -------------------------------- - ---- - -------------------=------------- ------------ ---------------------------------------------------- -------------------------------------------------------------------------- FINAL INSPECTION BY;.--� D ate----- -[_Z U.............. �..�`__�� __. .� - { SAN JOAQUIN LOCAL-HEALTH.QISTRICT 130 South American Street t 300 West Oak Street 132 Sycamore Street 014 North "C" Street ; Stockton, California Lodi, California Manteca, -California Tracy. California A l _,` 'J t t a ;Es-9 2M Revised 8-'59 FYCo. ,� '