12574 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. (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 described. This application is made in compliance,wi.th-Counfy,P.rdinance No. 549. JOB ADDRESS A_y L ,TION---- - --- ------ -- ----- -- .... .. -------- Owner's Name- ---- ----- ------------- --. Phone----••-----•----------------------- Address------3 -- - - - -- - -------------- --------- - ----------------------------------------------------------------------- ------------- Contractor's Name.----------------_ ------------------------------------------------------------------ Phone Installation will serve: Residence 0 Apartment House ❑ Commercial 2-01TIailer . o rt E] Motel 0 Other ❑ r.,00 sr Number of living units- -------- Number of bedrooms -------- Number of baths{." ot cze ....... —--—------------------- Water Supply: Public system I.--Community system El Private [] Depth to Wafer Table _.el ,g' ft. Character of soil to a depth of 3 feet: Sand E] Gravel D Sandy Loam E] Clay Loam 0 Clay [-] Adobe 9?-<ardpan El Previous Application Made: Yes E] No New Construction: Yes R?'% I-] FHA/VA: Yes F] No F] TYPE OF INSTALLATION AND SPECIFICATIONS-. (No septic tank or cesspool permitted if, ublic sewer is available within 200�eel.l ... ... .. Septic Tank: ...........Maferk_ _-A.e------------- ----------- Distance from nearest well Distance from foundation- No. of compartments-------9---------------size__;*_X'.3_(...........Liquid clepth------q._.7A--------Capacity.... ._* Disposal Field: Distance from nearest well.{ :_Distance from founclaflon-,X0..........Distance tc'nearest lot line__s---------- Rr-1- Number of lines----41---- Length of each line---- of'french___;,__$/ly...... Type of filter materia C'Z;Z-Depth of filter material----1-f----------Total length`_________________- __10-__--_-------. Seepage Pit: Distance to nearest Distance kpmPunclafion.... ---.Distance to nearest lot Iin------t�_** ip� Number of pits--------/-----------Lining ma, Size: Diameter-- ---------.Depth ...... ;Z --------------- Cesspool: Distance from nearest well-----------------Distance from foundation____________'_ Lining material--- --------------------------------- ❑ Size: Diameter--------------------------------------Depth-----------------------------------------------------LT u-id Capacity` -----------------------gals. Privy: Distance from nearest well-----------------------------------------------.-Distance from nearest building---11 '----------------❑ -------------- , 'i Distance to nearest lot line------ ------------ ------------------------- - ------------------------------ ----------------- j --------------------------------------------- Rernocle4ing and/or repairing Idescribe):----------------------------------------- ------------------------ ------------- ------------------------------------------------ ----------------------- ---------------------------------------------------------------------- ---------------------------------------------------- ------------------------------------------------------ ------------------------------------ ---------------------------------------------------------------------------------------------------------------------------------:----------------------------------------------------- ---------------------------------------------------------------- ----------------------------- ----------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances. S law i�and rulernand regulations of e San Joaquin Local Health District. (Signed)------ -- --1-------- A----- -- --------------- --- ------------------------- wrier and/or Contractort), -------- --- - ------ ----------- --------- By...__.......... ...............___............------ --- --------------------- - ----- - --------------------(Title)-- ----- --- .................... (Plot plan, showing sto wells uiize of lot, location of system in relation Idings, etc., can be placed on reverie side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED ----------------- DATE-----1-1,2------- = -------------------- REVIEWEDBY------------------------------------------------------------------------------------------------------------------------------- DATE------------------------------------•-------•-------------- BUILDINGPERMIT ISSUED------------------------------------------- --------------------------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations:----------------- ------- ---------- ------- - --------------------------=--------------------•-•------ - ------------- ------------------------------------- ---- -- - ---- ----- -- ----------------------------------------- -- - - ---------- ---- - ------ -------------- ------------------------------ - ------------------------------- --------------------------:--------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------I------------------------------------------------------------------- --------------------------------- - ----- -------------- ------------------------------------------------------ FINAL INSPECTION Date- ----- /---------------------- --------------- SAN ..........._-------- --------------- SAN JOAQUIN LOCAL,HEALTH DISTRICT 1.k V 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 Revised 8-'59 F.P.Co.