11913 - Laserfiche WebLink

Home Browse Search

A APPLICATION FOR SANITATION PERMIT" Permit No...... 11111.2 V �,? i, S (Complete in Duplicate) �T Date Issued This Permit Expires 1 Year From Date Issued _____________� flApplication 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. CATION ---JOB ADDRESS AND 7-0-4/ "4}49. Owner's Name--------- `] � ------•----- ------ --- -- --- • -- ----------------------------------------------------------------------- Phone-_/�__--_3 3 Address---------------------------- --------------- Contractor's Name -------- _ _____-__-- Installation will serve: Residence 29'"Xpartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __/__ Number of bedrooms __._ Number of baths /_____ Lot size ___+ XJ .10 ----------------------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table --- ---- ft, Character of soil to a depth of 3 feet: Sand ❑ Grave! ❑ Sandy Loam E❑ Clay Loam ❑ Clay ❑ Adobe, Hardpan ❑ Previous Application Made: Yes ❑ NON New Construction: Yes ❑ N.X 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 ----------------- Distance from foundation -------------------- Material __._________________-______-____._____.___._- No. o€ compartments Size-------------------------------- Li uid de th_ ________.____.___.-.-__ Capacity ❑ pq i? P Y jj Dispo I Field: Distance from nearest well-_�istance from foundation:Zo Distance to nearest lot line ---_7-.� Number of lines____________ _ ___ __ _____-__ _Length of each line ------ -- _ ___-_____ _ Width of french-.A-��// --l' ----3 Type of filter material_-__ Depth of filter material-_=/__-___.____ tal length_____.3_�S_______________ Seeyae Pit: Distance to nearest well ---- �7istance`fro fo ndation---%�- ____._.Distance to nearest lot line___d _�. Number of pits _=__. f ___________ Lining material ----- /._.Size: Diameter___ j..��------ Depth__ '!-___-_.. \ , esspool: Distance from nearest well --------------- __Distance from foundation -- -----------------.Lining material ______-____-_______.____._____-____-_ �I ❑ Size: Diameter---------------------- --------------- Depth ---------------------------:---Y------------------- Liquid Capacity----•----- ------------------ gals. �r Privy: Distance from nearest well ____.-_-______________________________________Distance from nearest building ---_.__.________.____.__--___--_-_.___-_. I ❑ Distance to nearest lot line ----------------------------------------------------------------------- Remodeling ano/or repairing (describe): ----------------------------------------------------------------------------------------------- --------------------------------•--------------------- �" ! ---------------------------------------------•--------•----------------------•--------------------------------------------------------------------------------------------------------- ---------------------------------- I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinances.- State laws, and rules a gula ions of the San Joaquin Local Health District. (Signed)% Owner and/or Contractor By------------------------------------------------------------------------- ___ ----------------------------------------------------- [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____._ REVIEWED BY ------------------------------- BUILDING PERMIT ISSUED_____________ Alterations an r reco endation -------=----- ------ --------------- ------- ------- -------f ------------------------- ---------------------------- ----------------- ------ --------- ---------------- DATE ------------------- -------------- DATE --------------------- -------------------------------------------------------------------------------------------------------------------------------------------------- G.' FINAL INSPECTION BY:.. - ------ Date ..__.1---------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton. California Lodi, California manteca, California Tracy, California ES-9-2M iv Revised 8-'59 F.P.CD.