17208 (2) - Laserfiche WebLink

Home Browse Search

OIC OFFICE USE. ,511, APPLICATION FOR SANITATION PERMIT Permit No. __�. ----------- --- --------------------------------------- (Complete in Duplicate) - ( P ._-------------------------------------------------- -_ I - 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 --------- --------- --- + Owner's Name---------- e ll ------- -- ----- rf- - ------- - Phone------------------------------------ ----------- •-------•--•---•------•--------•--- ---- ----- ------- - - ----�-----------------------------------------I.........-•-•----•----------------------------•-------------------•---•------------ Contractor s Name--------- -- ----- - 4or- •-- - -----------.-.-----------------------------------------------.. Phone- Installation hone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [3 Other I] r t Number of living units: ---L_.Ntunber of bedrooms _3---_ Number of baths -2— Lot size __-__-__--1-5----------1 Q_0 _---_-_---____ Water Supply: Public system VrCommunity system ❑ Private ❑ Depth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe V'Hardpan ❑ Previous Application Made: (If yes,date--------------------) No [n' New Construction: Yes ❑ No [3- FHA/VA: Yes [D. No Eq— 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 from foundation--------------------Material--------------------------------------,_----___-- No. of compartments------- ------------------Size---------------------------- ---Liquid depth-------------------- -----Capacity----------------------- �Dipo, 1 Field: Distance from nearest well---WQ_'N_,..Distance from foundation-----/_Q----------Distance to nearest lot Number of lines-------------� _- Length of each line-r2 b-"T--- Q_----.Width of french------Z---,---------- ---- Type of filter material___ �t_z=_ p g , ___De Depth of filter material_____�.�---__._,____Tota! length -_...__--__-._ . ) Seepage Pit: Distance to nearest well--- Distance from foundation-----/_4_f__.-_.Distance to nearest lot - - line___-`_'-_--.- Number of pits matenal_____��.GCl__ Size: Diameter_ - T�- ------- Depth--------3;---r------------- Cesspool: Distance from nearest well-----------------Distance from foundation-------------_.----.Lining material---...._.__-__._____._-______-____.__ ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity-.--------------------------gals. Priv Distance from nearest well-------._--_.--------------------------------------Distance from nearest building � ❑ Distance to nearest lot line---------------------------------------------------------------------------------------------------------------------------------------------- V1 Remodeling and/or repairing (describe):-------- ------------------------ --------------------------------------------------•--..-.-------------•-----•----------------------------------------------_--• -----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------:----------------------- .____-_________-____________________________________.____.___________.-__-_______________-__________-__-________________.________-_______________-__-__-____--__---_______.________________--___---- ----------------- o -----------------------------_------ _________________________________________________•_--_...-_-_--__-__________--___---________-.--_____---_-_-_---_----_____---____---_--------_____-_-_____.._-.-__________._.____..__..._ Ir 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 Joaquin Local Health District.,- (Signed) _(Owner and/or Contractor r Sy:----------- iC-- ------------------------------------{Title)------------------- ----------------------------- --- ---------- (Plot - --- (Plot 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------------ �--------- ------------------------------------------ DATE----------- --------------------- REVIEWED BY------------------------• ---- ------ --- - ------------------------------------------------------------------ ------ DATE------ ------ - ---- - -- ----------------------------------- BUILDING PERMIT ISSUED------- ----- ----------•---------------------------------------- ------•--•-----------•-- -------.. DATE------------------------------------------------------------- Alterations and/or veto ati ns_____________________________________ -�------ ' ------------ ------------------------------------------------- ---------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ FINAL INSPECTION BY:---------- cr ------------------------- -; SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street l Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 5-59 31A 3-'63 F.P.CD. `