20129 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: Ii, - --- ------ ----------------------------------- 11 APPLICATION FOR SANITATION PERMIT Permit No. ......... ----------------------- - ---------------------IM--- (Complete in Duplicate) S- ----- Date Issued ._�..=1�_--�� ------------- --------------------__---____________ ___ This Permit Expires 1 Year From Date Issued Application is hereby made oto the San Joaquin Local Health District for a permit to construct and install t e work herein described. This application is made in compliance with County Ordinance No. 5,49. f��`y��•�tJ� SIU ; � JOB ADDRESS LOC TIONJ� -,G�-`.-� .r&�f f, c - - --- ---- I Owner's Name SII �d "r. -------- -------- Phone Address1 -------------------------------------------------------------•-----------------------------._......----------- Contractor's Name------- �'` ror-------- Cl-'P - ------------------------------------------•----------------- --------•----- Phone------.-------------_ -------••- !II Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel E] Other ❑ Number of living unite: ___ _ Number of bedrooms __/-_- Number of baths --,'e--- Lot size .0-4 �G� _ _____________________________ Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table `�'�ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: 11f yes,date.....- ... -.....I No ❑ 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.) �!I Septic Tank: Distance from nearest well--/�Distar� from foundation---A�_1----.Mater� ____________ No. of compartments----/--`- Size- ----- ' ---_-:_--Liquid depth-----jC�.---___---Capacity-- _--_-- Disposal ield: Distancelfrom nearest weK/ --.Distance from foundation,/------_-.Distance to nearest I line_Z,Q-�-_- Numbed'of lines-----Z_._____/__.__ ____II_��__Length of each line_4 l---------------- Width of trench__,---------------------------- ------------------------- Type �___.-----_-.--_-.-- ' Type of,filter material e-G__Depth of filter materiaL._� Total length_.t ______ __________________` ,�, ` N I Seepag it: Dis#ance'to nearest well_ r --_--Distance fr m/�fo ndation_��_-.--.Distance to nearest lot iirge_lG9__---__ [ Number'of pits-------�----.______Lining material. v--Size: Diameter_3�'�--------------Depth_ I-:� _,�' I FCesspool: Distance from nearest well-----------------Distance from foundation____----_-----------Lining material_-.---__-_--._.---_--..---.----_.__ ❑ Size: Diameter---. ------------------Depth----------------------------------------------------Liquid Capacity- ----------- ------------gals. Privy: Distance fror Knearest well _______________________-.-___---..------------Distance from nearest building------------------.----------------------. 1n ❑ Distance to nearest lot line------------------ -------- ------------------------------ -------------------- --------------------------- --------------------- ----------- -and/or repairing (describe)------- ------- - ------fit ��1--/- `------------•------- k ---------------------------------------------------------------------•------------------------------------------------- IP -----------------------------------------------«---------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Coun+y ordinances, State laws, and a'�rulesanregulations of the n Joaquin Local Health District. F (Signed) mad/or Contractor) BY:-------------------- ----------------------------------------------- 11r {Ti+le) � � sr (Plot plan, showing size of lot, location of system in r ton to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED�3Y_____________ _ __ _ `f Gt DATE REVIEWEDBY-------------------- - --------------------------------------------------------- -------------------------------- ------- DATE-----------------------•------------------------------------ x4BUILDING PERMIT ISSUED11--------------------------------------------------------- --------------------------------------------}DATE--------------------- ------------------ ---------------- Alterations and/orre�commewndation;:-----------—W ________________ - ------------------------- Jlam_ -- IIP--------- ------------------------ --------------------+- -------------�---------�-4_`A_ ..--• ---- 'T------------------ ; ------ ----------------------- 'll� --------------------------------------------- ------------------------------------------------------- - -- ------ ----- s FINAL INSPECTION BYi._. ___ .. - � ' .-------------- Date----- - - - - ------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hasellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California yIIF.P.CC. + �