22016 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: ------------------1-/----- /Date ermit No. _ APPLICATION FOR SANITATION PERMIT . -------- ----- (Complete in Duplicate) Issued J--1Q__: � ------------------------ ----------------- 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 in compliance with County Ordinance No, 549. JOB ADDRESS AND LOCATION__- ,:7,.s"f------- __A17------ `------------------------------------------- ---------•--------------------------------- Phone ---------- t � Phone-------------------------------- Owner's Name_________,�� --- -- - -�-7- �------------------------------ ------------------------ Address ----------------------- Add ress----•-------"*5�'o&-------_------------------ r y -- Contractor's Name------------>� -fly_ ---------------•--------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑! Motel ❑ Other ❑ Number of living units: __. _ Number of bedrooms A_. Number of baths _L--_ Lot size _Ifger.&-O-------------------------------------- Water Supply: Public system ElCommunity system L] Private og"'IDepth to Water Table _ ft. Character of soil to a depth of 3 feet: Sand L] Gravel F1Sandy Loam ElClay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date_.---- __.------._._) No R? ' New Construction- Yes ❑ No I' FHA/VA: Yes ❑ No ®r I TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tan)k:,. Distance from nearest well-----------------Distance from foundation--------------------Material__._.____...___-._.-___._._.._____----.----_----. apacity C `No. of compartments--------- --- ---------------- -- ---Liquid deth �+ /s�:'_._.._.Distance to nearest lafi line4r�_________._ I Disposal.Field: Distance from nearest well.i-.-----_Distance from foundation_.._ f Number of lines-------------Z,-- ----------- Length of each line___/999-------------Width of trench_�----- ------------ i Depth of filter material___ ._ _-�'_.___Totai length__.�� 10 �=-------------• '�0* Type of filter material� _, �( !� - Se4page Pit: Distance to nearest well---_-----------------Distance from foundation----.--------------.Distance to nearest lot line__.___________.__ ❑ Number of pits-------.---------------Lining material------------ .........Size: Diameter----------------------Depth--------------- ----------------- I Cesspool: Distance from nearest well-----------------Distance from foundation--------------- _--.Lining material-- al-- t ❑ Size: Diameter- --- --------- --------- ------Depth----------------------------------------------------Liquid Capacity--------------------------- g V 1 Privy: Distance frorn nearest well-------------------------------------------------Distance from nearest building-----------------------------------------. ❑ Distance to nearest lot line- ------------------------------- ------ ---------------------------------------------------------------- - ----------- - i � 6 - --- --- -----••---------------- Remodeling and/or repairing (describe):------------ - --------------------- ---------- _-_----__ _..___._ ____________ ____ _ __ _ ______._______________________._._-____._-___--____-__-__- _-_-_ _-_ .__.-___.------------------------------------____ _ ' r+ify th_ ____ at I have prepared this application and that the work will be done in accordance with San Joaquin County ! hereby te and rules and regulations o ordinances, State laws, f the San Joaquin Local Health District. ..- (Qw /or Contractor) (Signed)-- ----------- ------------• -- :--- ---------- --------- -------- ----------- ----(Title)--- --- By------------------- ------------------------ (Plot plan, showing size of lot, location system in relation to wells, buildings, a+c., tan be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_ -------------------- DATE n- b� * DATE-------- --------------•------------------------------------ REVIEWEDBY-------------------------------- ------------------------------------ ---- ---------------- DATE------------------------------------------ -------------- BUILDING PERMIT ISSUED----------==------------------------------ ----- --------- -------------------- Alterations and/or rRcommendations--------------------------- -------..------ - -------- - ----•--------------------------------------- f ------------------------ --- - --------------------------------- - -- - ---------------- I FINAL INSPECTION BY:.�. -- ----- -- -------------- Date......... 1' ----------- - ----------------- ---------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haiellon Ave. Soo West Oak Street . 124 Sycamore Street 20S West 9th Street MManteca,California Tracy,California Stockton,California Lodi,California F.P.CC.