12027 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Per No. (Complete in Date Issued-1 ��-- - Duplicate) �y 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 with County Ordinance No. 549. 1 JOS ADDRESS AND LOCATION / - z - � ------------ n Owner's Name. --• Phone S�r �, !- Address_ r j------ ---- ------ ---- ------- Phone, L� Contractor's Name -= r � _ t = f Installation will serve: Residence bj<partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __/' Number of bedrooms f-_ Number of baths --/-- tot size ._� _ e ---------------------------- Water Supply: Public system TCommunity system ❑ Private ❑ Depth to Water Table 'T:ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel E] Sandy Loam❑ Clay Loam E] Clay [-] Adobe ardpan El Previous Application Made: Yes ❑ No [RNew Construction: Yes ❑ No 2— FHA/VA- Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) e ,i Distance from nearest well_________________Distance from foundation-------------------Material---------------------------------------.---__.__. L No. of compartments----------------- -------Size----•---------------------------Liquid depth-------------------------.Capacity-----------_- -------- ispd Id: Distance fromt nearest well_________________Distance from foundation______.-_____._____.Distance to nearest lot line----------------- Number of lines---•-------------------------------Length of each line------------------------------Width of trench <. of filter material----•---- --- - --- "epth of filter terial---------------------Total length------------------------------------------ Type Dist ce f m and tion__ / Distane to nearest lot line________________ Seepage ifi: Distance to nearest weP�Gf�__ �' f--� g Number of pits.-----�-------------Lining mate ial_` CSF -.Size: Diameter------9-,6---------Depth___��------------------- Cesspool: Distance from nearest well_________________Dista foundation___-_...__-.___.--- Lining material-----------------..--__________--_..__41 ❑ Size: Diameter--------------------------------------Depth------------------------------------------- ------ Liquid Cap acity---------------------------•gals. Privy: Distance from nearest well_________-_________--------------__._____._---Distance from nearest building------------------------ t ❑ Distance to nearest lot line----------------- ------------ ---------------------------------------------------------- O Remodeling and/or repairing (describe)----=---------------------- -----------------------------------•-----------------------------•-----------------------------------------------•-------- ---------------------------------------------------------------------------- --------- -------- A -------------------------------------•--------- I hereby ertify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, tate laws, and s+and regulations of the San Joaquin Local Health District. / ! �,�� C ---------------------------------------- -(Owner and/or Contractor) (Signed) Com-"- �E"=ext' ------ �J by:------------------ ---------------G ------------------------------------------t7itle) ---- ----------- ------------------ (Plot plan, showing`size of lot, location of system in r tion to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- ---- = - -� ---------------------- DATE ---- --- 6--------------------- REVIEWEDBY------------------------------------ ---------------------------- ----------------------- ---------------------------------- DATE--- --- BUILDING PERMITy ISSUED----------------- -------------------------------------------- --------------=---- ---._ DATE------------------------------------------------------------- Alterations and/or recommendations:------------ -------- --•-•-----•"----------------------------•---------------------------"--•---••-•--------------••------------ = ---------------------------------"--------------------.--••-•-----------•-----------------•-•------------ l _ --•-----•--------------------••-- d ------------------------------ -------------------------------- ------ ---------------- __ ----------------- ------- --------- 1 '. Date_" lG�� f� FINAL INSPECTION BY:-- +- ------- - ---- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 914 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 6-'59 F.P.Co.