20019 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: i ------------------- --------- --------------- APPLICATION FOP,. SANITATION PERMIT Permit No. -r.�-Qf.,l... - -- -------------- ---------- ---------------= - --- (Complete in Duplicate) Date Issued _______________________ ___ This Permit Expires 1 Year From 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-i.n,compliance with County Ordinance No. 549. u 4E-i- JOB ADDRESS AND LOCATION---- r 1D e is -,. !�------- I = ''r-[''E { 'fes 1 Owner's Name �'�r =.� - ---- Phone---- -- ----------- Address_... - ��`�'f ---------- ----- ----------------------- Contractor's Name_ xkx�� - f"P `�' �� ------ --------------------------------------------------------------------- Phone------------------------- --------- Installation will serve: Residence I]o`. Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _/_----- Number of bedrooms _ __._ Number of baths _.._ Lot size - . ------------- ----------------•------- Water Supply: Public system ❑ Community system ❑ Private [�j 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: (if yes,date-------.------------) 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.) Septic Tank: Distance from nearest well---------- Distance from foundation____.____.__.____-.Material-.._._.__-__-._.__.______..______-_____________- -J [] No. of compartments----- -------------------Size--------------------------------Liquid depth---------------- ---------Capacity--------------------•-- Disposal Field: Distance from nearest well_5°'_�-_._Distance from foundation/4$_'_.-1----------Distance to nearest lot Number of lines- ------- ------------ � Length of each line------I--ltd?-------------.Width of trench.-.__` z'--------------------' Type of filter material•_i.iE'C i____.-__Depth of filter material_____ _- ------- -Total length___J_�______- _____________1 I Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line---------------- F1 Number of pits--(---- --------------Lining material---------------------- Size: Diameter---------------- ----Depth------------------- ! Cesspool: Distance from nearest well_----------_---Distance from foundation--------------------Lining material__..____-----------__------_----- ? E l Size: Diameter--- --- ----------------------------Depth---------- -----------------------------------------Liquid Capacity------------------ ---------gals, i Privy: Distance from nearest well-------------------------------------------------Distance from nearest building--------------------------------------- Distance ___._____.___._____- ____-__..___Distance to nearest lot line---------------------------------- ---------------------------- ----•-------------------------------------------------------------- Remodeling and/or repairing (desciibe}:----Ae_>W_-- '` -----------------------------------------------------' -l -------- --------' F-- I I � •., j ------------------------------------------------------------------------------------------------ --------- --------------------------------------------------•--------------------------------------------------------------------------------------------------------------------------------------------------------- -- - I hereby certify that 1 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. (Signed)---- ------------ ------------- -------------- ------ - ------.(Owner and/or Contractor) W •� Y BY -------- -= ------------------------------------------------ -(Titl`e) -. —� (Plot plan, showing size of lot, ocation of system in relation to wells, buildings, etc., can be placed on reverse side). l FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED 13Y_4471, we ----------------- --------------------------------------- DATE - a -------------------------------- REVIEWEDBY----------------- ------- ------ ------------------------------------------------------------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED--------------I- ------------------------------------------------------------------------=-------- DATE------------------------------------------------------------ Alterationsand/or recommendations--------------- --- ----------------------------------------------------------------------------------------------------------•------------------------------- 1 -- ------- ------------ ----------------------------------- -- ----------------------•-------------------------------------------------•----------------------------------------------------------------------------------- ---------------------------- --- ------------------------------------------ - - ------------------ ------------------------- t -----•------- --- FINAL INSPECTION BY: ------------------ -------- 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 Tracyr California r.P.r G. f`-