20834 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: _ APPLICATION FOR SANITATION PERMIT Permit No. ..... . ----------------'----- --- -- -------..�:_Z0---- (Complete in Duplicate) ,�- �i& ----------`----- _--"_________________________________ This Permit Expires_I Year From Date Issued 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 Ordin ce No 549- Q.' JOB ADDRESS AND LOCATkO/N�� J-.. / -------------------------------------------------------------------------------------- Owner's Name_ �1/m Y°� L� aka ' r---------------------------------------------------------------------------------------- Phone----------------------------------_. Address----._ 5". ..... ----------•-----------------------------------------------------------------------------------------------------•• --........I—.................................. Contractor's Nam c_t_ T� --------- -- - -------- Phone................................... Installation will serve: Residence eApartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -- Number of bedroom_ s __ Number of baths __1__._ Lot size __, _x '�4____________________________________ Water Supply: Public system Community' system [_1 Private ❑ Depth to Water Table A ft. Character of soil to a depth of 3 feet: Sand [[ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe,®--_A`ardpan ❑ Previous Application Made: (If yes,dote---"____------------) 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.) 1 Septi nk: Distance from nearest well_________________Distance from foundation--------------------Material ___._.________.._-______..._______....________- No, of compartments.................---- - Size-------------------------______-Liquid de th__.______._.____..______--Ca Capacity_ ----�--- - Diseld: Distance from nearest well....----------Distance from foundation---- 4------------Distance to nearest lot line__'___-_____ Number of lines------I---------------------------Length of each line__&7't-40-___.-.Width of trench----A9_.--_____.._______.___. Type of filter materia7�_o__Gt----------Depth of filter material *:._.___-__.Total length--------./`5�-_ � Seepage Pit: Distance to nearest well-!`- from foundation_-_ZP_ ' "�" ____.__.Distance to nearest lot iine..S�_-_.. � I [ Number of pits_----/---------------Lining material a.G- -.---Size: Diameter-_2_,. ',.__._'---Depth-----'�5- --------------- d Cesspool: Distance from nearest well-----------------Distance from foundation------ lining material_ ---- ------------.----------------- 0 ❑ Size: Diameter--------------------------------------Depth------- -------------------------------------------.'Liquid Capacity----------------------------gals. iPrivy: Distance from nearest well______ -----------------------------------------Distance from nearest building::.,,_-.______._---_.--______--.---__---_. ❑ Distance to nearest lot Iine--------------------------------------------------------------------------------------------------------------------------------- ------- O i Remode4ing and/or repairing (describe):--------- - ---------------------------- ------------------------------------------------- -------------------------------------`-----------•----- --------------------------------------------------------------------------------------------------------------- ----------------------------------------------- i � � r f 4 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, nd r les an r gulations of the San Joaquin Local Health District. (Signed) [f ------ ------------------------------------------------------------------- (Owner and/or Contractor) ---Title (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------- -Zo----------------------------------#-------------------------------- DATE------ ✓ i - s ------ REVIEWEDBY----- ----------------------------------------------------------------------------------------- ------- ------------ ----. DATE----------------- ----------- - BUILDINGPERMIT ISSUED-----------------------------------------------------------------------------------"------------------ DATE-------------------------------------------------------------- Alferat ns an /or recommendations---------------- ------ -- ---- ---- '� ! ------------- •------------------------- �- ---------- ------------------------------------------- -------- - -------------------------------•---------------- -------------------------------------------------------------- . --------------------- -------- ----- --- ------- --- - ------------------------ ----------------------------------------------- -------------------------- ------------ -------------- FINAL INSPECTION BY:.. Date---------- �`' SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E,Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street . Stockton,California Lodi,California Manteca,California "` Tracy,California F.R CO.