19399 - Laserfiche WebLink

Home Browse Search

/ ._rROFFICE USE , t U� --------------------- APPLICATION FOR SANITATION PERMIT Permit No. ....1 -3- -------- -----•---------------- --- --- ---- --- -- (Complete in Duplicate) A" + 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 L a CAT ��- f�``'P�. -- ------- - Owner's Name------ —- ------------- Phone-_-------------------------------- Address------- ------------------- ---- Address__----- Contractor's Name-------- -'------------------------------------ ---:--------•-------•--•-------------------------------- Phone------------------------------------ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __l..- Number of bedrooms _A__ Number,of baths _ -- Lot size _ _ .! __ ----------------------------- Water Supply: Public system vllc&mmunity system ❑ Private ❑ Depth to Water Table _ ft. Character of soil to a depth of.3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 0'O'Hardpan ❑ Previous Application Made: 11f yes,date..------------------1 No Vl/'New Construction: Yes ❑ No Z?FHA/VA: Yes ❑ No R;.— TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) + Septi Ta k:, Distance from nearest well-----------------Distance from foundation--------`----------Material_.-.-----...----._.---_--.._----___-_____..__-. depth-------------.---- ��4 f ILIO. of compartments------- -- - - ------ ---Size-----------------------------Liquid dep./ --------Capacity----------------------- 1 Disposal Field: Distance from nearest well.____'—^"_- Distance from foundation---��.......Distance to nearest lot line__v�_y.__----- Number of lines-------- -------- Length of each line__ � � g tz�Q------------------Width of trench.j�..---�;--------------------- Type.of filter material � ..-_.__Depth of filter materiai_��---_._--_-Total length_----- ---------------------------- Seepage Pit: Distance to nearest well-------- fr m foundation---/j_______.Distance to nearest lot 1f11_4 - ------ U31— Number of pits--..--/-------------Lining material-- -G _.Size- Diameter& ---W--------Dept h_,207/0 Cesspool: Distance'from nearest well-----------------Distance from foundation Lining material----------------.___-._-_______--_-_-_ ` ❑ Size: Diameter---4-�------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals, Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------ ____..-_. ❑ Distance to nearest lot line----------------------------------------------------------------------- ---------------- Remodeling nd/ r epairing (describe):_.__ . r�A1 " ----------------------------------------- ----------------------------------------------------- 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 regul flans of the San Joaquin Local Health District. (Signed)---------------------- ------ -------l- j - --- ---- .--------------- ------------------- -- --------------------------------- for Contractor By:--•--------------------------------------------------------------- ----(Title)-- ----- -.- - (Plot plan, showing size of lot, location of system in relation to w , buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------ - - - - ----- - ------ ----- ---------------------------------------- DATE----- -f `s-y ---- --------------------- REVIEWEDBY------------------------------------------------------------------- - -------- -----•------------- -------------------------- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED-------------------- / DATE------------------------------------------------------------- Alterations ------------------------------ - ----------------- Alterations and/or recommendations:. /_-------------------------------------- /------------------------ -------------------------- --------------- ------ -------------------------------------------•- -------------------------------------------------------------------------------------------------------------�-------------------- FINAL INSPECTION BY:.-------1 x---_-.- .. _ -�1(----------- �' 6 ---------- Date -------- --------------- SAN JOAQUIN LOCAL HEALTH DISTRICT x 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.F.C Q. 3