19773 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: ----- --- ----------- -------------------------------------------- 'E APPLICATION FOR SANITATION PERMIT Permit No."/1_pp _ � 3-- . --------------------- ------------ --- --------- II (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 with County Ordinance No. 549. a� : 1010 /cfZ- �� F Goix:r X668 _ 40 JOB ADDRESS AND LOCATION-----t------/ �� `'� '" �" Owner's Name---------+�� * � ------ --------------------------- ------- ---- -- - ----------------------------- ------------- Phone------------------------------------ --- - Address----------------------�•+- 2'----' Contractor's Name G- --•----------------------------------- --�----Z''---f----- -------37 �,.L-__. _ Phone-----------------------••--------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __t.___!, Number of bedrooms _4--.- Number of baths � Lot size _ _ __ - _-_._______________.________....__.- Water Supply: Public system ❑ „iCommunity system ❑ Private J • Depth to Water Table 10_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam C Clay ❑ Adobe ❑ Hardpan i Previous Application Made: (If yes.,dote-------.--_.-------.) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ i TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool 'permitted if public sewer is available within 200 feet.) }� Septic Tank: Distance from nearest well-----------------Distance from foundation__._-_______!____-_.Material----------------------------------------------_. li �I ❑ No. of compartments- - --------------------Size--------------------------------Liquid depth--------------------------Capacity_-------------------- Disposal ..------------ ------- p a. s �r cS+ Dis osal Field: Distance from nearest well_-_-._._.___._-Distance from foundation_____ ______________Distance to nearest lot line-________-_-.._-. p�r '] Number of lines.__.__I__+ra,-_1dFd __ Length of each line---� `_ Width of trench---,.. ------------------------- Depth _f + T e of filter materia yp Depth of filter material.... Total length___ o_' _ n Seepage Pit: Distance to neares well1 ------------Distance from oundation___' -------Distance to nearest lot line-s?_------- no ______n Number of pits__---------------Lining material_._._..Size: Diameter_..._-P-✓-.y____-_.Depth___,Ar`?------------------- c)` Cesspool: Distance I nearest well-----------------Distance from foundation....................Lining material._-.__--------_----.---_______.____-_. SizeDiameter-III ,. ---------Depth--------------------------------------------------Liquid Capacity- - -----------------------gals. Privy: Distance from nearest well--------------------------- ---------------------Distance from nearest building----------.-__.---------_-_-____-...___--- ❑ Distance to neat rest loft line----------------- --------- -----"------ ----- ------- ----------------------------------------------------- Remodeling and/or repairing (describe):_ � 'l _ , - --- -- --------------------------------------------------- ......... .... ..... . . .... . ----------------------------------------------- ------------------------- ----- ---- ----------------------------------------------------------------------------------------------------------------- .i - ------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------- 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, and rules and regulations of the San Joaquin Local Health District. I (Signed)----- _-V----------- '--- ---------- ---------- - ------ ----- - - ------------------------------------------------------------------------(Owner and/or Contractor) By:--------------------------------------------- _ -----.-- ----- ---=---:----------------------------- -- -------aF-mar-----(Titla)------------------------------ -------------:..F.---------- - -r- •. (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY i APPLICATION ACCEPTED B ----- ---------------------------------------- DATE_.//--1--.6'r------------- ------------------ REVIEWED BY-------------- l ------------------------------------- ----- ------- ---------- -------------------------- DATE---//-Y``-----f- ------- -- - BUILDINGPERMIT ISSUED----------- "----------------------------------------------------------------------------------------- DATE------------------------------------------------------------- Alterationsand/or recommendations:---------------------------------- -------------------------------------------------------------------------------------- ---------------------------------- -- f { ------------------------------------------------ - - ------ -- ---- - - ---- - - ------------ ---------------------------------------------------------------- ----------------------------- - - Z FINAL INSPECTION BY:.. . ---------- ------------- Date.//. SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. s 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracyr California 4 r