20305 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: --- -- ------------------ APPLICATION FOR SANITATION PERMIT 2 Permit No.-,m., 5-�-`- ---- ------------- -------- ------------ --------------- p: (Complete in Duplicate) "Date Issued --------- ------------- This Permit Expires I Year From Date Issued Appli anon 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, JOBADDRESS AND ------Ow- 4",��................ ----------------------------- ------------------------------------------------------- 41 ------------------------------- - Owner's Name--------- - - --- ------------------------------------------------------------------------------------------------------- Phone_.. ----------------------------^------------------------------------------------------------------------------------------ Address----------- ------------------------- -------------- --------------------------- Contractor's Name--------------------------------------------- --------------------------------------------------------------------------------- Phone..._.... - I Installation will serve- 'Residence X__KParfmenf House ❑ Commercial [] Trailer Court 0 Motel [j Other [I Number of living units: ---I---- Number of bedrooms Number of baths -.2---- Lot size ------------------------------ Wafer Supply: Public system E] Community system El Private 0 Depth to Water Table _A15- ft. Character of soil to a depth.of 3 ..feet: Sand 0 Gravel E] .'Sandy Loam 0 Clay Loam 0 Clay 0 Adobe &—Rardpan 0 Previous Application Made: ..(If yes,date-----------!------ ) No New Construction Yes �No �'FHA/VA: Yes E] No rT— TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se T & Distance from nearest well________________Distance from foundation-- -----------------Material------------------------- ---------------------- P No. of compartments-" rfments-. - ---------------------Size-1-----------------------------Liquid depth--------- ........_------Capacity----------------------- Dis Distance from nearest well_________________Distance`fro?h foundation--------------------Distance to nearest lot line________________- Number .of ine----------------- Numberof {fines------------- --------------- ----Length of each line---------- -------------.Width of trench--------------.--------------------- f Type rench----------------------------------- Type of filter material________________________Depth of filter material-----------------------Total length_____-_-.___________._.__________________ Seepae ength-------------------- --------- SeepaVDistance'to nearest well--—----------------Distance from founclation-1t..............Distance to nearest loll line__-__._____ 00 Number of pits---1--------- ---Lining material Size: Diameter---:;U--- -------Depth-----Z6—---- I - ------------------ Cesspool: Distance from nearest well------ ---------Distance from foundation - -----------------Lining material------- -------------- -------------- `U� ❑ Size; Diameter---------------------------------------Depth-------------------------- -------------------------Liquid Capacity---------------------------gals. Privy: Distance from nearest well-- -------------------------------------------- Distance from nearest building_._____:___:_________.____._------_..._. ❑ Distance 0ding--------------------------------- -------- Distanceto nearest lot line------------------------------------------------------ --------------- ---------------------------------------------------------------------- ---------------- :30 i��_ Remodeling and/or repairing (describe)- ------- ------ I(describe)_________ ___ ,/- -------------------/------- ----------------4:------------------------------------- --- ------ - ---- ----------- --- ------------- ---------- --------------- _4 - - ----- A------- ----------- ------- --------- -------- -------------------------- ----------------------------------- ------ ---------- 9 --------- ------------------------- 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, ry�d rules reg uU ations of the San Joaquin Local'.Health.District. / ) (Signed)------------------- ------------------------------------------------------ ---(Owner and/or Contractor) ----- ------------ ------------ ----------------------------------- -- - -------- By:-------------------------------7--------------------------------------------------------------------------------------------------_(Title)------------- ----------- ------ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc.,-can be placed an reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY.____ ------ - --------- - --------------------- -- ---------------------------------------- DATE__ :t?----------------------------------------------------- FREVIEWED BY---------------------------------- - ---- -- --------------- ------ ------------------------------------------------------ DATE----------------------------------------------------------' BUILDING ATE----------------------------------------------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------- ---------------- DATE------------------------------------ ------------------------ I �ons ancjtor recommenoations:------ ------- --- ---------------------------------- - - ------------------ --------------*--------------------------------------------------------------------- ----------------- ,&te iOi --------------------------------- ----------------- --------------- C- 10-1------------------------------------------------------------------------- _ __4. - ---------- /-------------------- -------- ----- ----------------------- ------------------------------------ --------------------------- -------------------------------------------------------------- - ------- -------------------------------------------------------------------------- ---------------------- ---- ---- - ------------------- -- - ----------------------- -------------------- --- ------------------------------------------- ------- ---- -------------------------------- FINAL INSPECTIONS BY:........... ---------------------------- ---- -- ---- Date...._. ,6 4 ----------- – -------------- ...... -------------------- --------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Maxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California r.p.co.