12902 - Laserfiche WebLink

Home Browse Search

FOR OFFI E USE: APPLICATION FOR SANITATION PERMIT Permit No. --2..9..a--? ✓ � - ------ (Complete in Duplicate) Date Issued . �3 -- --------------- ----------------- ------ This Permit Expires 1 Year From Date Issued App lication 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 LOC TION...._-:._.-- �'' - Owner's Name Phone-----••---------------••---•---•---- Address------- y - ` = ' --------------• -- --•-•-----•-------------- Contractor's Name..----_--_ r Phone------•---------------- ---------•-- Installation will serve: Residence ❑Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _1--- Number of bedrooms .-3-_ Number of baths ---I.... Lot size ._/,77 -°�' ------=----------•--------- '"_""""':. ." lte CI—Depth to Water Table Tr ft. Water. Supply: Public system {�Community system b—'154 ate ❑ Dep Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [I Clay ❑ Adobe[1—Hardpan ❑ Previous Application Made: (If yes,clote---------- ---- -} No ®' New Construction: Yes 2' No [] FHA/VA: Yes E] � No [ TYPE OF INSTALLATION AND SPECIFICATIONS: i I (No septic tank or cesspool permitted if'public sewer is available within 200 feet.) i f 17, t Septic Tank: Distance from nearest well from foundation----._-_----.--___.Material_-----.---____----- p❑t� No. of compartments----------------- Size-_.------------------ 1------,-Liquid depth--------------------------Capacity...-----•-------------- 1) Disposal,Fi Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line---------- � Number of lines=----f--------------------------Length of each line------------------------------Width of trench-------------------------------------- Type of filter materiai----.-------•------------Depth of filter m - aterial-----------------------Total length----..-.-------- � •--- , Seepage -it: Distance to nearest well,_-2id2",e-------Distance from foundation--- ------------D'sstan�ce to nearest lot line _.. Number of pits-----/---------------Lining material-. j x -Size: Dia meter----33........---Depth---- - '-----•------.------ Cesspool: Distance from nearest.welL-:^�Distan e from foundation---------------__Lining material.-.-----------..-__----------••------ ❑ Size: Diameter----------------`------------ ---------Depth - :------------ ----•-- '--------- Liquid Capacity gals. E, -- --- Distance from nearest building--------------------------------- Privy: Distance from nearest well. --------- ,. } € ❑ Distance to nearest lot line----------------------------- Remodeling and/or repairing (describe)--------- --------- - -------------------••-----••------•------------•---•--••-•-------•------...--------- --------------------------•--- r ••-----------------•----------------------•-----•--"- •------ ---:--------_--•----•--••----•------------•------------•---- I -------------------------------------------------------- ------------------------------------------------------------- --------------------------------------•----•-------------------------------•--------.--------------..----.--------- 1 hereby certify that I have prepared this application an'd that the work willfbe done in accordance with San Joaquin County ordinances. State laws,.and rules and regulations of the San.Joaquin Local Health District. -----I----- --•-----------••---- -----------------------------------------(Owner and/or Contractor) II -------------- ------------- -------------- ----- ---- - (Title) ---- � ---- --- (Plot plan, showing size of lot, location o i relation too wells, buildings, etc., can be placed on reverse side]. I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-----+�--=.--- ------ - ( y -------------- DATE----- , - ------------------------------ REVIEWED BY------- ---------------•------------ -------------------------------------- ---------------------•------------------ DATE--------•-•------------•------------------------------------ BUILDING PERMIT ISSUED--------------- -•--- - ------------------ DATE------------------------------------------------------------- -. Alterations and/or recommendations:-_l` 'fi---)-`l.-5f_,_1-0_'y : t�- ' a --•-----------------------------------------•------•----------•---------------- ----------------- ------------- ------•--- FINAL INSPECTION BY:-----C--.----�---------------•------- -------- Date------- "+ t----------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street r� Stockton,California Lodi,California Manteca,California Tracy,California .._9 REviarD B•s9 r^co.1M 6.60