18576 - Laserfiche WebLink

Home Browse Search

j FOR OFFICE USE: ' -------------------------------------- - APPLICATION FOR SANITATION PERMIT �Permit�No. .../... --•- A - --------- --------------- 'Complete in Duplicate) Date Issued ---�--3-10.- --------------------- -------------------------- 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. JOS ADDRESS AND LOCATION.__,, __.---r - J �/` --------- _ r f1- < _, _..-- ... ---------------------------- Owner's Name /�. 'fl-C� .� � �a -lV Phone_ i-`l -. •. Address----•I------------------------------I------ --------- Ci � s ` ------�--=-`-"------------------------------------ Contractor's Name---------------------------- --/p- . ~�` ��-------- ---------------- Phone_ ------ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Mafiel ❑ Other ❑ Number of living units: __I_-_ Number of bedrooms ---__-__ Number of baths _/.. Lot size �--------------------------- Water. Supply: Public system (R"'Community system ❑ Private ❑ Depth to Water Table -------- ft. Characteraf soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam [I Clay Loam ['Clay E] Adobe [3 Hardpan E] Previous Application Made: (If yes,date--------------------) No E;---New Construction: Yes ❑ No [3----FHA/VA: Yes ❑ No [j TYPE INSTALLATION AND SPECIFICATIONS: t� (No septic tank or cesspool permitted if public sewer is available-within 200 feet.) Se •c�Tank: Distance from nearest well_________________Distance from foundation--------------------Material------------------------------------------..---_. I p . No. of compartments-- -----------------------Size--------------------------------Liquid depth---------- - -----------Capacity----- .............. # Disposal Field: Distance from nearest well-----_~_------Distance from founclation__ .9_.f'fT)istance to nearest lot line__--- Number of lines---------�-- -- ----------- --Length of each line---__— -------------.Width of trench_._._-�`'/----=-------- De Depth of filter material --_.._Total length__ a�p------------------------ Type of filter material__ �1��JP p V . / ------- Seepage p0 Seepage Pit: Distance to nearest well-___.-'�-____-___Distance fro foundation________. __ _ �stan to nearest lot line__1f __-____ Number of ts.____. Linin material_` Size: Diameter... -_--.Deptn-_-_ ---------------- r..M p - 9 Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining materia4__._..-_.---._._---___._-------___.__. ❑ Size: Diameter----- --------------------------------Depth-------- - -------------------------------- -------Liquid Capacity----------------------------gals. l Privy: Distance from nearest well---------------------------------------------- --Distance from nearest building----------------------------- ------ ---- ❑ Distance to nearest lot line---------------------------------- - - --------- ---------------•--------------------------------------- ------------ ---------- --- ---- O - de Remodeling and/or repairing (describe):_____ --- 1 --------- ------ ----------------------------------------- ---------------------------------•--------------- ----------------------------------------------------------------------------- ---------- --------------------------------------------------------••-------------------------------------------------------------------------------------------------- -------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ; i ordinances, State laws and rules and regulations of the San Joaquin Local Health District. s - '� ---------------------------------- (Signed) ne nd/or Contractor) -- � - --- ----------- ------- ------- ------------------------- - -- I (Plot plan, showing size of lot, location of system ' relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_._. - ------- f DATE--------E3 _7 -� ^----------------- REVIEWED BY------------------------------------- ----------------- -------------- -------------------------------------- DATE---------------- ----------------------•------------------ 4 BUILDING PERMIT ISSUED------------------------------------ DATE Alterations and/or recommendations: __------------. _ _ --------------•---------------------------------------•-•------------------------ -------------- ----------------------------- r f�= -----------�--------------------------------- --------------------------------- --------------------------------------------------- ------- Uf ------------------------------------------------=-----------------=---------------------------- --------------------------- FINALINSPECTION BY--------- - ------ -- Date--.----- ----------- ........ ........... --------------------- ------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1t10! E.Hazelton Ave. 300 West Oak Sliest 124 Sycafnore Street 205 West 9Th Street Stockton,California Lodi,California cinteca,California Tracy,California F.P.0 O- " y f f