16125 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: 7,,ick } �` r • APPLICATION FOR SANITATION PERMIT Permit No. ..l..W_l. ��.... . ------------------- ----------- -- (Complete in Duplicate) Date Issued ___�___�:�� 3 - -------------------------------------------------------- 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 wit C� nt Or/in�ace No. 549. A71 .,N... N - ""JOB ADDRESS AND).QC - :�' ---------------------------------------------------.--- Owner's Name---------- ------ -------- -------------- Phone.................................... Address----------------------- --•--.!-_ J .............................................----- Contractor's Name-----.___ ___ -----------------� -_----•---- Phone................................... Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---I. Number of bedrooms Z_ Number of baths/------- Lot size _-_-� ----__--------- Water __.•-_-----_--•Water Supply: Public system �ommunity syttem ❑ Private ❑ Depth to Water Table___1�7 Ckoi Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ Previous Application Made: (If yes,date_.__.._'__,..__-) No New Construction: Yes E] No [3./FRA/VA: Yes F-1No TYPE OF INSTALLATION AND SPECIFICATIAS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material---------------.--.---- ..--_--_-_...._._...... ❑ No. of compartments-------------------------Size------------------------•---=---Liquid depth----•--•------------------Capacity------ ---------------- Disposal Field: Distance from nearest well-----------------Distance from foundation................:---Distance to nearest lot line................. ❑ Number of lines-----------------------------------Length of each line..--__--___-.---___---__.----.Width of trench-__-.--__-..-,._-_-__--_-.-.____--_ Type of filter material-----------------_ Depth of filter material-----------------------Total length--_-____:-_._-_-----_______-_-_-_______--- ' Seepage Pi • - Distance to nearest Distance from foundation,,1A----- ------Distance to nearest lot *ine.S_.._..._.._ Number of pits---------- -----------Linin g material..7 C' ..Size: Diameter___ _ _ 15Z.-.._Depth------------- ------------ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material--..-.-.-.-.•-_____---_-___-______-_-. ❑ Size: Diameter--------------------------------------Depth-----. ------------•------------ --------Liquid Capacity- •-----------•--------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----------__--_--___-.----._-._--_--_--.-. ❑ Distance to nearest lot line--------- ------------------------------------ ---------•------------- •--------_---------------•-----------------•-•------------------- Remodeling and/or repairing (describe):----------------------------------------------------------------•-------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------- -----------------------------------------------•------------------------------------------------------------------------- ------------------- -----------------------------------------------------------------------------------------------------------------•---------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------- --------------t hereby c ify that eve prepared this application and that the work will be done in accordance with San Joaquin County ordinances, tate I % nd les and regulations f th San J quin Local Health District. - s (Signed -- and/or Contractor) --------- -- --------------------------------- By:--------- - - ---_---------- --- -• -----------------------------.--------------------------------------(Title)- ----- ..-- --------- (Plot plan, sho size of lot, location of s em in relation to wells, buildings, etc., can be placed on reverse side. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- ---------- ':. -t,CO ------------------------------------------------------ DATE-------- 4IR-7( _3------------------------- REVIEWEDBY---------------------------------------------------------------------------------------------------------------------------- DATE----------------------------------------------------------- BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations:..-.___ ------ . ------------------------------------------------------- -- ----------- ------•--•-------•-----•. . -------•--•••.... --------•--•••...._......__..._....------------------•--- ------------------------- ------------ ..... --------------------------------_. ------------- ---------------------------------- FINAL INSPECTION BY:---------- ------------------------------ Date-------7= .,,t_Anb a------------------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. - 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED B-59 3M 3-'63 F.P.DD.