19038 - Laserfiche WebLink

Home Browse Search

rrt F R OFFICE USE: s'�l 5 ----------- ° } a ------------------ €x __ APPLICATION FOR SANITATION PERMIT Permit No. ,l_ _��-----�___- - ------------------------------------------------------- (Complete in Duplicate) / .-_. ---.--- This Permit Expires 1 Year From Date Issued bate Issued 5_1 �__ CSS Application is hereby made to the San Joaquin Local Health District for a permit to construct ana install the work herein described. This application is made in compliance with County inane No. 54 �y JOS ADDRESS AND ION---- ----------------------------------•--------------------------------------------------- fI Phone.Owners Name ------------------------- ----- ------.-••-- -- ----- ----------------- Address______ -Contractor's Name - - --------------------------- ---- ----------------------------- ------------------------.. Phone----------------------------------- Installation will serve: Residence Apartment-House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _ __ Number of bedrooms _,5__ Number of baths- ___ Lot size _______________________ Water Supply: Public system ❑ Community system 05- �rivate ❑ Depth to Water Table "_ ft h Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay [] Adobe _�iardpan ❑ Previous Application Made: (If yes',date--------------------) No .a-lf 'New Construction: Yes ❑ No �FHA/VA: Yes Pg-- No ❑ r TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ' Se c TLA k: Distance from nearest:welL___µr----Distance from foundation__/�--------Mate ial -.- ._:_ _. W No._of com artments_.._ -_.Size_ -7. Li uid de th____ / . - Ca acitDIV is ol Distance from nearest well.---. _.__Distance from foundationQ p p y p ____l�_~__.Distance to nearest lot line_��—__�_____- 5,5 ', Number of lines_____.__�_._ - ---- ---�--/-- ---Length of each line__4-a ___-_._.Width of trench_z_-._�__,..----..-__..._------.r - Type.of filter material //�fG.__Depth of filter material._ ��__..________..TOtal length__,-_�_:-__________________ dp'"' See a e Pit:� Distance to nearest well_._._'._—_._______Distance fr f,°.�dation----------_________.Dista ee to nearest lot lin J ��J Number of pits______ ____________Lining material--- -Size: C sspoo : Distance from nearest well----------- --Distance from foundation._------------------Lining material..........--------------------------- O ❑ r S;ze: Diameter-------------------------------------.Depth----------------------------------------------------Liquid Capacity- ----gals. F f IPrivy:- Distance from n ar:est.well_________________________________________________Distance from nearest building-------------------------------------- ❑ r Distance.to nearest lot line----------------`---------------------- Remodeling and or re rin 9 / P 'ring (describe}-_- } y -- ------... --------------------------------------------- --------- f - --------- /1_0----•-- t. --------------------------------=-------- ' = --------- -------------------------- 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, anti les and regula ions of the San'Joaquin Local Health District. , Si h6d - -✓ - �-- I { g ) :. . - {C e"vi or Contractor) -- ---- ---------------- Title ' Y ----- - -------------- (Piot plan, showing size of lot, location of system in ref ii to wells, buildings, etc.; can be placed on reverse side). FO DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - -------- DATE----.. ~' `---" 5 -------- --- REVIEWEDBY-------------------------------- -- ------ ------------------------------------------------------ DATE----------------------------------- BUILDINGPERMIT ISSUED-------- ---- --------- ---=-`---------------------------------------------------.------------------- DATE------------------------------------------------------- --- Alterations and/or r comm ndations: _ .._l� .__ !Z _L_t�_ ..._,..__._ y --------------- f �� FINAL INSPECTION BY:.... ----- ----- Date._.-_ -__-_I .' _ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. $ 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy, California F.P.ro.