20820 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: i -------- ----------=----- ------------ -- - ------------- APPLICATIONY FOR SANITATION PERMIT Permit No. _ .�� .... t } [Complete in Duplicate) Date Issued " FM- : This Permit Expires 1 Year From Date Issued --------------------------------------- District for a permi to construct and install the work herein#scribed. Application is hereby made to the San Joaquin Local Healt This application is madg in mpli cep hC unty rd' c 49. ` .. IS �r7,�,e<, JOB ADD L ATION_�-------- -------- --- Q , Owner's Name r/l --- ---------------------- ------------------- Phone '- Address -----------•------------------------ Contractor s •Name-----------------------------� --------- - ----------- ------ Phone--------------------- ------------- - Installation will serve: Residence [� Apartment House ❑ Commercial ❑ Trailer Court ❑ M�tel ❑ Other ❑ Number of living units: J_-- Number N\umber of bedrooms ._��'__ Number of baths 7�_ Lot size -3-/ -_ - -------------------------•-------- Water Supply: Public system ❑ Community system ❑ Private k Depth to Water Table 6--b ft. i Character of soil to a depth of 3 feet: Sand ❑ GravelSandy Loam ❑ Clay Loam [IClay F] Adobe ❑ Hardpan-El Previous Application Made: (If yes,date-------_---.-------) No X' New Construction: Yes No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: . ` - [No'sep#ic tank'or cesspool permitted-if public sewer-is-available within 200 feet.) ` r s y t i SeR'c Tank: Distance from nearest well...&_0---_Dis#amcp fro unq tion-/O-----------.Material--- - ___ .-- - ------ ------ P �rJ - No. of compartments �� ------Size- /} - -----X-- ---Liquicl depth _ -----f ----Capacity--- Distance f r� found tion___ .. _-_--__.Distance q�vearest lot line__ Disposal Field: Distance from near st well__._ __ ��gg � p� Number of lines_-- _ _ 9 `T//T-7— - /I `. . _ Length of each line------------r.__._ ---- t rich- - ---------=------- Type of filter materia!_`. _-� i "---De th of filter material____. /- _1 ---Total length------- ----- Pit: Distance to nearest well---r---------------Distance from foundation--------------------Distance to nearest lot line.-___..______-.._ ❑ Number of pits---------------- --Lining material------------------=----Size: Diameter-----------------_---_-Depth-------------------------------- j Cesspool: Distance from nearest well_________._- _-Distance from foundation.___...._-_TM.?Lining material_____________________________________ is- El Diameter_ -----_ Depth---- ._-- -- ---- r----- --- Liquid Capacity -;�� 9a ------ Distance ----Distance from nearest building-- ------------------------------------ Privy: t Dystance from nearest well------❑ �' Distance to nearest lot line------- ----------------- --------------------_ -----------•------- ------------ Remodeling and/or repairing {describe):----------------- --------------- --- ---------------------------------------------------------------------------- ------------------------ --- -------•----------------•------------------•-------------- ----------------------------- ---------------------- ------------------------•------------------------------------------------------•---------------------------------- I hereby certify that I have prepared this application and that +he work will be done in accordance with San Joaquin County ordinances, State laws, and rule nd regulations of the San Joaquin Local Health District. ._.Owner and/or Contractor) > (Signed) N^, -------------------------------------- --------- - ( - - _---- _ ,_�-_----=-_..-----(Ti+l By(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 APPLICATION ACCEPTED BY------ ----- DATE---- ---------------------------- y REVIEWED BY - - -._ DATE /.- - j r� BUILDING PERMIT ISSUED--------------- -------------- ----------------------- DATE - --------------------------- ---- Alterations and/or recommendations---------------- -------- ------ -----------•---------------------- --------- -------------------- ------ ---- --- . -------------- FINAL INSPECTION BY:-...- .... ..�.----- __. ---PG�----------- ... - !% ------------------ -------- Date_ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haseltan Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street i Stockton,California Lodi,California Manteca,California Tracy,California F.P.EO.