15975 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: ---- ------------ APPLICATION FOR SANITATION PERMIT Permit No. ..!>S•11X ---------------------------------- ------------- (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 AND OCATIOIV..-----(� --�------�•--------C9l��G�l-.---��-��ic�--------------••---------._...---- ----------------------- •---•- Owner's Name--- -••- —-�� ---• Q �- ------------------ Phone.................------------------- Address.......... -•---------•-•--- Address----•--•--•. - �-- __. •------•-•-------•--------------------= Contractor's Name..........------ - .... --------------------------------------- -• - - - Phone..............-------------------- f Installation will serve: Residence l,�/partment House ❑ Commercial E] Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .-I.... ber of bedrooms'2,_. Number of baths l----- Lot size _______________________________•___.---------------------- _ . Water Supply: Public system Community system ❑ Private ❑ Depth TO Water Table -------- ft. Character of soil to a depth of 3 feet: Sand E3 Gravel [I Sand 1 am E]. Clay Loam [I Clay ❑ Ad be ardpan ❑ Previous Application Made: {If yes,date--------------------) No New Construction: Yes E] NO ❑ FHA/VA: Yes E] No a� 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-----_-----------Distance from foundation._______....__.____.Material_______-_______..._____._-_.---•-_._-------.____. ❑ No. of compartments-----------------------•--Size--------------------------------Liquid depth------- ------------------Capacity---•-•----------------- _________________Distance from foundation to nearest lot line................. Disposal Field: Distance from nearest well ❑ Number of lines-----------------------------------Length of each line-.----------------------------Width of trench----------------------------------- Type of filter material-------------------------Depth of filter material----------------------- otal length--------••---•------.-------------------- Seepage Distance to nearest w ll__.____.•-__ __ Distanctj•'from fo ndation.�e._._....__.Distance to nearest lot lines_--_______. n Number of pits___________________Lining matarial__:��---Size: Diameter__ __..........Depth_c�:7.,52_______________ Cesspool: Distance from nearest well-----------.__Distance from foundation______--------------Lining material-...____-_-_-__.___.____---______---- [l Size: Diameter---------------------- ---------------Depth--------------------- ----------------------------_Liquid Capacity-----_----------------....gals. Privy: Distance from nearest well--------------------------------------- ______Distance from nearest building____-__________..._-.___-.----.____.-----. ❑ Distance to nearest lot line------------------- ---------...-.-----------------------------------------------..------------------ c ---------------------•--------- I Remodeling and/or repairing describe]:-:-------------��L.�=��-- �•-�=�-?----•--•-------- ------------•--------------•-•---••--- ---- -------••-•---------------------------------------------------- --� I ------•---------------------------------------------------_-1 ------------ __--------------------_-_---------------------------------------------•-----•-••--------••--•-•----------------•-------- hereby certify hat I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, rules a r ul tions of the San Joaquin Local Health District. (Signed)--•- ------------ By: -- --------- ---- - ----------------------------------- ----------------- ------------ --------•---- {Owner end/or Contractor] By:------------------- -- ... ------- ------ (trio) 1�G" (Plot plan, showing of lot, location of system in re a ,on to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------ DATE__-____4__ _1X`4-3__._____._ ----- `-- ---�J --------------- �- -- ---------------- REVIEWEDBY-------------------------------------------------------------------- ----------------------- DATE--------------------_------------------------------------- 1 BUILDING PERMIT ISSUED•------------------------••------------------••------ ---- - -- ----- DATE..----••--------------- _ r - -----._.,�------ y�--------- ti Alterations and/or re,commendatians:__--__.. —�r�-�'' ` - � '`-------- /� -------�-j-----------)---gyp -- ------------------ FINAL INSPECTION BY:. -..%c ct� = Date---- - --�� 9 SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 91h street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8.59 2M 8.82 ATLAS