21379 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: 7Z,�_ /C15/)--- APPLICATION APPLICATION FOR SANITATION PERMIT Permit No. . .�J�. _ ----------------------------------------------------- -- (Complete in Duplicate) Date Issued Z-2-- :K�� ---------------------------------------------- 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. S49, JOB ADDRESS AND LOCATION--------- - ----S- s ---- 5 ------------------------------------------------------------------------------------------------ Owner's -------------------- Owner's Name----------------_V__1---------------------------------•-----------....--------•-•-•--------------------- ------------------------------------------ Phone----••-------------------------- - Address-----------------------•-------------•-----•------------------------------------------------------------------------------------------------------------------ Contractor's Name----------------V�-------- ------------------- ---- �_t=------------- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel El Other Number of living units: ---!---- Number of bedrooms _-3�--- Number of baths AL Lot size ------------------------------------------------------------ Water Supply: Public system ❑ Community system ED Private ❑ Depth to Water Table _`,I-_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam 0 Clay ❑ Adobe ❑ Hardpan [] Previous Application Made: (If yes,date--------------------) No ❑ New Construction: Yes 0 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 well---ko_0_._.Distance from foundation----. 0.:-_----.Material-------_------------___ t No. of compartments------------- ------- ---Size--------- f----------Liquid depth-----------`,-------------Capacity--------- ------ Disposal Field: Distance from nearest wl----l O_�__Distance from foundation_-_--�'-------.Distance to nearest lot line----------------- L F1Number of lines-------------- ---,---------------Length of each fine------- ------------------.Width of trench--------Z-----------.--------- Type of filter material __--!__4f----A_.__F__Depth of filter material ----___I-------------Total length--------W-;z--- ---------- Seepage -_Seepage Pit: Distance to nearest well---------_-----------Distance from foundation-----------_--------Distance to nearest lot line----------.-----_ ❑ Number of pits---------------------Lining material-----------------------Size: Diameter-----------------------Depth--------------------------------- Cesspool: Distance from nearest well-------- ------Distance from foundation-----.-.-----------.Lining materia)--..--------------_.--------_____---- ❑ Size: Diameter--------------------------------------Depth--------- ------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well--------------------------------_---------------Distance from nearest building----------.__._-_-----._.--__-____.---. L ❑ Distance to nearest lot line---------------------------------------------------------------------------------------------------------------------------------------------- Remode'ling and/or repairing (describe)---------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------- -------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------- -------------------------------------------I----------------------------------------I---------------------------------------------------------------------------------------------------------------------------------------- -- ------ -------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ 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. (Signed) -----------------------Owner and/or Contractor) By-------------- --------------------------- •--. ----(Title)----------------------- ----------- (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.B --- ----------------------------------------------------------------------- DATE----1CV's�ra-4F-------------------------------- REVIEWED BY----------- ------ ----- -------------------------------------------------------------------------------- DATE------------------------------------------------------- BUILDING PERMIT ISS ----- - --------------- DATE------------------- Alterations and/or recommendations:--------------------------------------------------------------------------------------------------- --------------•------------•-•------------------•---------. ---------- ------------------------ -------------------------------------------------------------------•-- ----------- --------- ---------------------------------------------------------------------•-------- - ------------------------------------------- ------------•---------------------------•-------•- ---- ---- ------------------ FINAL INSPECTION ^r --- --------- Date c ai 1 ----- . 1 - ?=�d ' ----- - ---------------------------- UIN LOCAL HEALTH DISTRICT 1601 E.Hasellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E$ 9 REVISED 8-59 3M 3•'63 F.P.CC.