18981 - Laserfiche WebLink

Home Browse Search

} FOR OFFICE USE: �__._�_ _ _ APPLICATION FOR SANITATION PERMIT Permit No. �u ------------ --f-f _p - (Complete in Duplicate) ------------ This Permit Expires 1 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 wok herein described. This application is made in compliance with County Ordinanc o. S49. ds 1 o _02— t} i�cs�► cl Z,'I5l- 3.1 JOB ADDRESS AND LOCATION__.__, ,04-V147l _ ___ _ __ ......... ------dl ... .... '' ------- ----------------------- Owner's Name________________ _ � _ - I Address__. / -QyIC -------------------------------------------•-•----f---�---------- .......... Contractor's Name_______-------- — ------- ---------------------------------------- Phone_ 5� _ .Q- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -..�- Number of bedrooms _.3. Number of baths ?s Lot size ____ 4 ale___________________ Water Supply: Public system Community system ❑ Private R9-4epth to Water Table �0d_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [T' Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (if yes,date__----_----_----___) No .❑ New Construction: Yes ❑ No ❑ PHA/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 ___._.._.-_----_..____.___.____________.____.. ❑ No. of compartments--------------------------Size------•--------------------- ---Liquid depth--------- ---- ---------Capacity-------------- ------- Disposal Field: Distance from nearest well---pol_'__Distance from foundation___._--.____Distance to nearest lot line__.�r!V___. Number of lines______ __ ------- /_ Length of each line------�3.Cl�_..__...__.___.Width of trench-_ `_ __._._______ 4 ---- - Type of filter material__ - &�Depth of filter material___1e_-.._.-----Total length_________43[---- �___________________ Seepa Pit: Distance to nearest well._/ ._ Distance fro foundation____30 Distance to nearest lot line__. Dumber of pits__.-___.�._________Lining material___ '. ze: Diameter___ ___------Depth-__' _____________._ e% Cesspool: Distance from nearest well_________________Distance from foundation------------------- material------------------------------------- S ❑ Size: Diameter-------------------------------------De th------.-----------------_------------------_- _Liquid Capacity __gals. Privy: Distance from nearest well_____ __________________________________________Distance from nearest building-___._____-______________----------- -. ❑ Distance.to nearest lot line-_-_- 0F,.____ ---- - ---- --- -------- Remodeling and/or repairing (describe)----- ----- --- �---------- / � .atG------� Jl/ --------- ----------------•---------------------------------------------------------- -----------------------------------------------------:------------------------------------------------- -- ------------------------------------------------------------------------------------------------------------------•--------------------•----------------------------------------•------------------------------- f -------------------------------------- ------------------------------------------------------------------------- --------------------•--------------------------------------------------11--------------------- --------- I 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, arue and regulations of the San Joaquin Local Health District. I Si ned ( g )---------------------------- ��--. -��'----------- - - ----- ner d/or Contractor] ---------------^--- ----------�n --- _A5 - {Title ------------------ - ) f------ ------ (Plot plan, showing size o ot, locat�onof �temnrelation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY I APPLICATION ACCEPTED BY --�" ------------------------------- DATE-------- REVIEWEDBY ---------------- --- ----------------------------------- ----- DATE----------- --------- BUILDING PERMIT ISSUED-------------- ------------------------- - - - — DA•Tc -- ons and/ r rec ------ r- ------Altera#iommendations-------- ------ f- --------------- -- ----------- rC#� ' - _ ��' ` ------ ------_ - - -� ------- -------:ateW-1-c--�---- „6- ----f-- t'-Q-r- ------ ---------- ---- --------- ---- - ------------------ l FINAL INSPECTION BY: - --- -- ----- ----�t2�� Date---------------------- S N JOAQUIN LOCAL HEALTH DISTRICT _ 1601 E.Hazollon Ave. ;30L West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California odi,California Manteca,California Tracy, California .r e t