20332 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: --------------------------------------_.----------- APPLICATION 1=0R SANITATION PERMIT Permit No. ---------"""--------------------------------------------- {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 LOCATION----------------�---------- Owner'sName �r 'L/----- e1 ----------•------------------------------- - ---------------- ---------------------- Phone"_...._".._-.----.................. - Address.......,,40�mf--------------•----------- ----- ---------------------------•---•------------ -- ----•-••---•---------=---------------------••-----•-----••------------•--•----••---• Contractor's Name ---- -- T ----------- Phone-----------------•--•-•---------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -1----- Number of bedrooms _•.3... Number of baths --Z-"Lot sizeA4f__._."-------------------"-__.___ Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table _k eft. , Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe a-14ardpan ❑ Previous Application Made: ¢1f yes,date----------- ------) No Cn7 New Construction: Yes ❑ No FHA/VA: Yes ❑- No [? ' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within.200 feet: Septi Distance from nearest well-_________...___Distance from foundation--------------------Material __"_"."""-"-"--"------_--_____"_...--_...______- j No. of compartments--------------------------Size!------------------------------Liquid depth---------------- ---------Capacity---------------------- Disposal Fled. Distance from nearest well---�(J./_-Distance from foundation___ a_--------.Distance to nearest lot line-_<---_-__ ❑ Number of lines_____ -------------- ------------Len6th of each ------------------Width of trench_"".""- �� --- ...._______ Type of filter material'71roCA, -----Depth of filter material----/J0------------Total length-------3-&-"�""""__-___..____"__". Seepage Pit: Distance to nearest well---&v_`_--------Distance from foundation e--�''____-___".Distance to nearest lot line.`- Number of pits------I--------------Lining material__'__�/ ,pc,.K...Size:_Diameter-_..3 ---.A-.-.._Depth_____'�'1__1_ ------------ C Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material--.---"_..--"._.-_.---_____._______- Size: Diameter_"________________ .De th _______Liquid Capacity----------------------------gals. Privy: Distance from nearest well---------------------------------------- ------- --Distance from nearest building---.-...""._".--_-_-________"_-_..__..._. ❑ Distance to nearest lot line-------------- ` 3 --------------------------------•---•--------•-------------------- --------------------------------------------- - } I Remodelingand/or repairing {describe}----------------------------------------------------------------•--•-------c--------------------•------------------------------------------ ------------ ----------------------------------------------•------------------------------------------------------- ----- -------------" "--------------------------------------------------------------------------------=----------- -- ----------------- --------- ------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------- I hereby certify thad have prepared this application and that the work will be done in accordance with San Joaquin County y ordinances, State laws d rules and reg do of the an Joaquin Local Health District. ` (Signed)---------- ---- --------r-------- -----------------------= ................... ----------------- ...................................... . -------------------------- ------ (Owner and/or Contractor) e gY:------------------------------------------------------------------------------------------ -----------------------------------------{Title}---------------------------- -------------- ------ ------- ---- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). t FOR DEPARTMENT USE ONLY 4 APPLICATION ACCEPTED BY-- ----- ---------- .------------------------------------ DATE-------------- / - -- BY REVIEWED ER........ I -- U - --------------------------------�- ------------ --------------------------.DATE' -` t BUILDING PERMIT ISSUED ------ - - -- --- DATE----...__ - - ' Alterations and or recgmmendations_-- - ----3-1 .... ., = ----- '�'--- 'i` --— �------`-C��c� 4. Gil �: ------------------------------------------------ ----•------------- -=----------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------ ------ ------ ----------------------------------------------------------------------------------I- ---------- -�----------------------------------------------------- -------- FINAL INSPECTION BY:. �� --- ------------ ------}--- Date----------- ............ t " SAN JOAQUIN LOCAL. HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy, California F.P.CO.