20522 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ate... -------------- ---------------------- ------------ (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 in compliance with County Ordinance No. 549. E j D/ Cf_ /70- p? JOB ADDRESS AND LOCATION/_/--. � - / _ Owner's Name---------- -094--- ---•- -6i--V, / ------------- ------------------- ---- ------ - Phone--7.2-7-5 ' Address--------------------------.-- .--------IP �Z_De ----------.-----. -.--------------- Contractor's Name---------- lP/ /_:S/z�__... ��Y,S`. ---------------------- Phone__ ��+ A.2----- r Installation will serve: Residence & Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _/---- Number of bedrooms _-' -_ Number of bathsl/A Lot size ---------------------- Water Supply: Public system ❑ Community system ❑ Private it Depth to Water Table lxU_'/ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam M Clay Loam 0 Clay ❑ Adobe❑ Hardpan Previous Application Made: (If yes,date.---------- ----....) No [3 New Construction: Yes ® No ❑ FHA/VA: Yes ❑ No Ek 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.,SO.......Distance from foundation, ------------Materialsl�'eGS%________________ Size q I? p y /d�Gl� -- � No. of Compartments------.a-------------- ��..IZ.�'-�,_--Li Liquid de th--��--------------Ca out ------------------.---- Disposal Field: Distance from nearest well Distance Distance from foundation-_lam./__----Distance to nearest lot line-_- ----- .---_ tA - Number of lines------ --------f---------_...--Lenpgth of each lined a_"�.S=1�4_Width ofgtrench---crZ_ `'_----..----_---_.- V) T e of filter material-- /it'a -----De th of filter materoall-____---_--_._.-Total len th_._.a 4O____ _____________________ Seepage Pit: Distance to nearest well-- �Q.�_----Distance fr m foundation__en0__f-------Distance to nearest lot line----4'------_ Number of pits------ -------------Lining material- -.Size: Diameter-_.V_ __"`_ Depth.... .;7,5----_----..---..- Cesspool: Distance from nearest well-----------------Distance from foundation------------------- Lining material---...._.-.---..-_-.--.--------_-.._-. ❑ Size: Diameter------------------------------------ Depth-------------------------------- --- --------------Liquid Capacity---------------------------gal . Privy: Distance from nearest well --------------------------------.---------Distance from nearest building-----------------------------.-------_-__. ❑ Distance to nearest lot line--------------------------------------------- ------------------------------------------------------------------------ Remodeling and/or repairing (describe):..... �`--------- - �--------•-- ------ -------------------•-------------------------------------------------------------------- ------------------------------------------------------------------------------- ----------------------------------------------------- -----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•---•------------- ---------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat�7� d rules and regulations of e SS:1 aquin Local Health District. �/� fc�/t -/✓S- ..... /f�C-------------------------- wner d/or Contractor) (Signed) A01- By:----------------- --- ----------------- -- ----------------------------------------------{Title)------ ---- ----- ---- ----------- ................. (Plot plan, showing size of lot, locati system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY C -S �'��.j3 ------------------------------------------- DATE......`? z_/�_-G -------- ----- - REVIEWEDBY-------------------------------- - -------------------------------------------- -------------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED----- --------------------------------------------------------- ----------------------------------- DATE--------------------------- ----------------- --------------- Alterationsand/or recommendations:----------------------------------------------------------------------------------------------------- - ----------- ---....---------- --------------------------------I-------------------------- ------------------------------ ----------------------------------------------------------------------------------------- ---------------------------------------- ------------ ----------------------------------- ------- ------------------------------------------------------------------------------------- --------------------------------------------------------- ------------------ FINAL INSPECTION BY:..----- Date--- �Z- ----- C3 SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California