20057 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: ' -------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. . p ... ------------- --- ------------------------------------ -- " (Complete in Duplicate) --_----------------------------------------------------- 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�3es_ This application is made in compliance with County Ordinance No. 544. ------------ JOB JOB ADDRESS AND LOCATION_______ _ ---- '`''' '`'`f--- -�--- Owner's Name---------- , r----------------- ---------------------------------------- Phone_"._.------------7 J/ F + Address....- -�-'-- -- f'� ` � = -' ' � �T q... Contractor's Name------------------------------- ------ Phone__44�"�`�r--- " Installation will serve: Residence Ig Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of.living units: ___ Number of bedrooms _-%3._ Number of baths _2,��Cot,size _ -----------___________ Water Supply: Public:system Community system ❑ Private ❑ Depth to Water Table ________ ft. 4 Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe'tK Hardpan ❑ Previous Application Made: (If yes,date____________________) No ❑ New Construction: Yes lK No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest wellfTD0_r Distance from founclation-J- -----°_.-.______. ❑ No. of compartments_________.-------Size---- __________ _______________Liquid depth____------------------Capacity_a- 0----- r f � Disposal Field: Distance from nearest well.:/+500 "Distance from foundation----/�_f-------- to nearest lot line._`*__...__. ❑ Number of lines------A----.-----__--_____Length of each line----- ---- ______- __-Width of trench_..._____�— �n G Type of filter material___-1 ir�k8'epth of filter.matenal d___X+-* _RTotal length_-..- �'" - Seepage Pit: Distance to nearest well----------------------Distance from foundation___________________Distance to nearest lot line----------------- []1-1 material___--_______.._-______Size: Diameter_____________ Number of pits.--------- - g ----------Depth--------------------------------- Cesspool: ----- ----------•----------Cesspool: Distance from nearest well---------_-------Distance from foundation_"..---------^___..Lining material------------------- V El, Diameter--- --------- ------- --------Depth------------------------------------------------ Liquid.Capacity-- ---- •-gals. Privy: Distance from nearest well"__ ------------------------------------------Distance from nearest building--------------------------------- ---_._. b ❑ Distance to nearest lot line------------------ - -----------------'---------------------------------- ------------ R Remodeling and/or repairing describe):---•- ---------- ------------------------------------------------------ ---------------- ------••-------•-------------------------------- ---------'----------------------------------------------------•----------------•-•-••----------- -------------•------------------------------------------------------------- ---------------------------------------------- -- ----------------------------------------------------------------------------------------------- -------- ---- '---------------------------- ----------------------------------------------------'---------•-------------------------------------- - 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 regulations of the San Joaquin Local Health District. Owner and/or Contractor [Signed] r - ------------------- -----------------t ( I ) By: . --- -•-------------------------------------------(Title)------- ------ ---- Plot Ian, showing size,of_lot, location of sy teinfi relation to wells, buildings, etc., can be placed on reverse side). _ [ P FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------------------------------------------------------------------------------------ DATE----------------------------------------- - ---------------- REVIEWEDBY---------------------------------------------------------- ------------------------------------------------------------------ DATE------------------------------------------------------------- BUILDINGPERMIT ISSUED----------------------------- ---------------------=------------------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations:-------------- --- --- ------ -------------------------------:...------------------••-------------------------------- ----- ---•---•---------------•--.•--------------------------------------------------------- -------------- ---------- -------------------.--•-------------------------•----------------------------------------------.------------ -------------------------------------------- -----------------------------------•-------------------------•---- -------------------------------------------------------------------------------------------- ------------------------------- •------ --- ---------------- ------- ------------------------------------------------------------------ ---------- ----- ---- -•----- -- -- ------------------------- --------------------------------- ---------------- ---------------- " FINAL INSPECTION BY------------- ----------------- ------- ------ --------------- Date----- l- � � �� ---------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 3M 3-'63 F.P.CD.