15512 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: ' ----------------- ------------------------------------- APPLICATION 'FOR SANITATION PERMIT Permit No. ------------------ -- -------------------------- ---- ------------------------ ------------------------- (Complete in Duplicate) Date Issued ---._ __ 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. JOB ADDRESS AN'D� OCATION. ]ru �G � Owner's Name_... y�_�____—___- Phone------------------------------------ Address------- ---------------•---.--------------- Address------- ..s ....... .... z° ------------ Contractor's Name_.zf '`-------------------------------------•-----------------------------------•-------•------------------------•--•--------------- Phone--_------••--•-_-_--------•-- Installation will serve: Residence 4 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: r(_____ Number of bedrooms ___ Number of baths _1____ Lot size ............. ____._....--______-._-_-._-____.._- Water Supply: Public system ❑ Community system ❑ Private Rr Depth To Water Table 3.0--_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel E]. Sandy Loam ElClay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No ® New Construction: Yes, ] 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: rDistance from nearest well------I---------Distance from foundation___________________.Material______.____-_--___________------...._________-_-. ❑ No. of compartments---------------t----------Size......-------------------------Liquid depfih -------------------------Capacity--••--------------•--- F. ... . .. Disposal Field: Distance from nearest well-SIO----------Distance from founds+ion__/Q_"____.____-.Distance to nearest 1�g t linel............ ] Number of lines______,/__. _.--------------- .Length of each line_;__O-------------------Width of trench__�T_ .....__________--___-__ �--� ='De a-� - ry Type of filter materia pth offilter material.----�Q_-____----'-Total length---10__---_---•---------------------- Seepage Pit: Distance to nearest well------------------------ from foundation.__................Distance to nearest lot line____.-___________ ❑ Number of pits-----------•'----- ---Lining material-----.-----------------Size: Diameter-------•----------------Depth----..-.------------------------- r - Cesspool: Distance from nearest w0l_________________Distance from foundation___._.______.______.Lining material•_._________-- ___________-_---_-_ Size: Diameter. f - -------.Depth ---------------------------------------------Liquid Capacity--------••---•------------•-gals. Privy: Distance from nearest well jl---=----- ---------------------- ------------Distance from nearest building------------------------------------------ Cl Distance to nearest lot lii`e ----------------•----•----------------••--------------------------•---------------------- Remodelingand/or repairing (describe):-------- --- -------------------------------------------------------------------•----•-•-------....----------------••-----------•-•---•--------•------- -•-------------------------------------•-•---------.....-------••-------•----•-----...----------------•-------••------•--------------••------------------•----------------------------------------•---------------- ----------- --------------------------------------------------------------------------------- ----------------------------------------•--...-..--------------•---.------------••-•----------------•-----------•--•-•----•--------•-------------•---•-•-•------•------------•-----••-=-------••-•---------------•---------------- ------------•-•------------------------------------------------------ --------------------------------- ------------------------------------------------------------------------------------------------- --------------- hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat laws, and rules and r gul ions of the San Joaquin Local Health District. (Signed)- --- --- --------------------------------------------------------------------••---.(Owner and/or ontractorl B -•-----------•• ------------------------------------------------------------ -------------------------------(Title)_.,_-_� _ _r_:_:-•=-- _ - .......--=-------- . . (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.. `'� ' REVIEWEDBY--------------------------------------------- ----------------------------------------------------------- DATE-------------------------------.-_---•-------------------- BUILDINGPERMIT ISSUED_--------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations---- ------------- --------------------------------•--•-------------•--------- .....-------------••------------------•-----•----••---------•------------------- FINAL INSPECTION BY:./ tom._ ------------------------------- Date-_ .`a ------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Svreet 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 2M 5-62 ATLAS