68-137 - Laserfiche WebLink

Home Browse Search

FQR�FFICE USE: -�s - .- J1 - --�. . --- APPLICATION FOR SANITATION PERMIT Permit No. _ ------- --------`�------ (Complefe•in Duplicate) .... —'This-Permit Expires 1 Year From Date Issued Date Issued ---_�5---�� Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. i" —This-application is made in compliance,with County Ordinance No. 549. JOB ADDRI=55 AND LQQATION. QV-4 - r. S--------------- Owner's Name--------- --- --- -a•------- � - ----�---- ------------ - Phone.- ress-Ad - Contractor s Hama _-`-- --------------•------------- Phone�6_��- -------- -Ole _. Installation will serve:j Residence 0 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -i----- Number of bedrooms 1--Number of baths.j--- " Lot size --14�---- - ---- ------------------------ Water Supply: Pub€ic system ❑ Community system ❑ PrivateX' Depth to Water Table 30- it Character of soil to a depth of 3 feet Sand [❑ Gravel [ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe J Hardpan ❑ Previous Application Made: {If yes,date------- I No New Construction: Yes B . No FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Y• Septic Tank: Distance from nearest well___-------------Distance from foundatio-- i___- .'-.Ma`terial ---- Capacity--,-------------------- Disposal __--.-- SII ❑jj6lS1 f49G No...of compartments-- •." .__.....Size--------- ---------- -----Liquid. depth"__ _ Disposal-.Field: Distance from near st well __��. .._.Distance from foundation o�Q_...I.Distance to nearest lot line-/"_,--. ry Number of lines_ -""-��- --------------Length of each line--.,, �--. Width of trench- .- ---- ---------------------- i Type of filter material___�Q ._---Depth"of�filter matePRai -_ -----Total length-,3 ----------------------- .� c SeeE page Pit: Distance to nearest well-t�-�-J1— _.__ p g - - ". Disfiance rom undation_--_ - �---"-..Dist ��a to nearest lot line-l-�.[l-v- Nu�ber of pits--C�_)--------- Linin material-� C • 9 -- --- Sue: Diameter.-�- --- ----- Depth-��----- --- --------- a Cesspool: Distance from,nearest,well ------------ Distance from foundation....-i-----------..Lining material------- -----------"-___-.--""-..-- ❑ Size: [diameter -- --------- ----- ----------------Depth----- Liquid Capacity gals . r : Privy: Distance from nearest well.-.."___ _________________----------------_____Distance from nearest building------..--____.-----.._----------------_-. ❑ k+ $ Distance to nearest lot line - - I---------------------------------------------------------------------------- i s I Remodeling and/or repairing(describe):.... 8 � • ----•------------ -------------------------• ---------------------------------•-------------------- ----- - -------------------------------------------------- ....... ----- -------------------------------- --- -------------:- ------ -- ------------------------------------------------------------•---- ---------------------------------------- I hereby cern I Rave prepared this application and that-the work will�be done in accordance with San Joaquin County j ordinances, State laws, an rules a regulations of th4SJoaquin Local Health District, (Signed)- - .-------- - ----------- -------------_------- - -----------------------—- (Owner and/or Contractor) By:. ---- --- . s.. - (Title) (Plot plan, showing size of lot, location of system in re anon to wells, buildings, etc., can be plat d on reverse side). FOR DEPARTMENT USE ONLY :a APPLICATION ACCEPTED BY - ------------------------------------------------------- ---------- DATE--- -~ ---------------------------- REVIEWED BY----- -------------------== -------------------------- --- -------------------------- ------------------- DATE BUILDING PERMIT ISSUED.----- • -- ------- -------------- -- ------------------------------------------------------ HATE----------------- - Alterations and/or recommendations----------------- ------- --- ------------l-f------------ - -"--------------------------- --- ------------------------------------------------------------ ------------------- -- '*-. ------------------------ ------------------------------11 ------------_-------------------------------------------- nn , �p , FINAL INSPECTION BY:.. r� ---- Date.------- ---v`� s `"6 SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:elten Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California E.H.9 2M 1.67 Vanguard Press