21944 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: ------------------------ ------------------ APPLICATION FOR SANITATION PERMIT Permit No. .. ----------------- ------------------------- ------ {Complete in Duplicate} ..-.--._._____________ __-----------------------____ ___ This Permit Expires 1 Year From Date Issued Date Issued ____ �lr ' � Application is hereby made to the San JoaquinY 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. JCrB";ADDRESS ANDL ATION ` �"� --- "'` "r`_ ........---------------------..........--------_------- Owner's Name--------- / ------ ------------------------------------------------------------- Phone37rrfr'Tez:.Acl�- Address � - . - Contractor's Name__.........-� Phone.�jlv�. ------ • Residence Apartment House Commercial Trailer Court Motel ❑ Other ❑ Installation will serve. ❑ p ❑ ❑ Number of living units: _//Number of bedrooms _,Number of baths ._�Z__. Lot size ---------0a.�'{...�°�- Water Supply: Public system E] Community system ElyPrivate It Depth To Water Table !-••o ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe O' Hardpan ❑ ` Previous Application Made: (If yes,date--------------------I No X New Construclion: 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.)n Septic Tank: Distance from neare�well _��Distance f;,om fo ndatpn_1Q /` a Material___________________________............._..____. ----_______4 No. of compartments_________ ____ ________Size_44---X -Liquuuid dep/h___''__C .�_______._Capacity_.,?s2_4V_0 .. Disposal Field: Distance from nearest well---"-"Distance from foundation-_1O---------Distance to nearest lot line.---______.. [ Number of lines___.,._.._ Length of each line_.______ _ C...Width of french.___ l2_!�.- �--------------- _ U,! Type of filter material..._ wDepth - f'filter material..--/- ----;-'__- otalWlengtii"___ __ ___ ____________ Se epa a Pit: Distance to nearest well_ p_�f__._ /Q Distance to nearest lot line--.C ____.._.__ ____Distance fr m f unda#ion__ ____.. .__.. Number of pits_____��_____-------Lining material__. __.___Size: Diameter---Ja3............Depth____�a ................ Cesspool: Distance from nearest well_________________Distance from foundation.------------------- material______-___.___________------....._-_ ❑ Size: Diameter---------------------------------- --Depth----------------------------------------------------Liquid Capacity.............---------------gals. Privy: Distance from nearest well--------------------------------------___________Distance from nearest building_______________----.._._._._______--___._. ❑ Distance to nearest lot line ----------------------------------------------------------------------------------------------•--------------•-----------------------------..., Remodelingand/or repairing (describe)---------- --------------------------------------------------•------------------------------------.....--•------...------------------------------------- -----------------------------------------------------------•------------------------------•-------------------------------------------------------------------------------------------------------------------- ------------ hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances. State laws, and rules and regulations of the San Joaquin Local Health District. ------ --------------------" --------- ---- ---------------------------------------.-•---- Ow {Signed)_______________ (Owner and/or Contractor BY� .r....... �1 ,,tiion ------ --- > -{Title) - showin size of los s min relation to wells, buildings. etc.. can be placed on reverse side). {Plot plan, gY FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY---- -- -•-- -----------------------------------------------------------------------------------------------------------•------------------------ DATE---------- r---!(1------------------- - REVIEWEDBY--------------------------------------------------------- ------_---------------------•------------------------•-•-----._.. DATE--------------------------------------------•-------------- BUILDING PERMIT ISSUED............. _---------------------------------------------------------------------------------- DATE---------------------------------------- --------_----------- Alterationsand/or recommendations:------- •--------------------------------------------------------••--------•-•---••------------•-----•----------•--------------.----------------------------•- -------------------------------•-•-----------------•--------_.-------------------------------------- -------------------I/----Z------------- ------------------------------------------------------------------------- --•-•-•-------------------------------------------.....-_----------------------------------- ------------------- ---------------------------------- ----- --------------------------•--•---------------•--•-------------..-------• ---------------------------------------------------- ---------------------------------- -•- --••- - -------------------- -------- ---- -- •- ----------------- ----- -----•- --------------------------------------------------- -- FINAL INSPECTION BY Date__.'` ... ----------------------•----•----•- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 340 West Oak Street 124 Sycamore Street 205 West 9111%Street Stockton,California Lodi,California Manteca,California Tracy,California ~, ES 9 REVISED 8.59 2M 5.62 ATLAS + j-