19609 - Laserfiche WebLink

Home Browse Search

FOR OFFICE U5E: ----- -------11-- qq " 6 APPLICATION FOR SANITATION PERMIT Permit No. ./2 o-l-___--- ------------rr----------- --------------------------------- -.--"- --1-- .- .G.=----- --�-� - [Complete in Duplicate) p -------------- This Permit Expires 1 Year From Date Issued Date Issued 9r - --------------- - t�' Application is hereby made to the San Joaquin Local Health District for a permit to construct 8nd install the work herein descri ed. This_ap lication is made,,i pliance with County Ordinance No. 549. JOB ADDRESS ANA L CATION_± - -------------------- --- --- --- ----- - °---"--��-�_ Owner's Name___ -.------------ -- --- --- - ----------- - - ------ Phone-- -• ------------------------- Address ---------- ---------- ------ -- ---•--- --------- •------------ - - ------- ----------------------- -- -------------------------- Contractors Name-------------------- -- -- --- --------- -------- - -- ------------ -------- - ---�`"�"`-�'--------------------- Phone.. ----------------------------- Installation will serve: Residence% Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __.,l_ Number of bedrooms _c.._ Number of baths _/__ Lot size ------- _____-___--_ Water Supply: Public system ❑ Community system ❑ Private 10 Depth to Water Table -�57e ft_ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Aclobak Hardpan ❑ Previous Application Made: (If yes,date-----------_--------) No ❑ New Construction: Yes ❑ Nox FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ank: Distance from nearest well_________________Distance from foundation----------------.-_.Material____-____-"--_-__---____"____________._._.______- No. of compartments-------------------- -----Size----------------------- ------Liquid depth--------------------------Capacity-------------- -------- Disposal Field: Distance from nearest weir©�_-_fi Distance from foundation___.,,o_,/_5_-------Distance to nearest lot line�_ _____�/ Number of lines___._______"._. __ _-_Length of each line___-____� ______-------_Width of trench------- f(___---------_------ Type of filter material- _E_ G/(__-Depth of filter material-__--1-19_- Total length___._------------------3- 40_ Seepage Pit: Distance to nearest ----Distan m foundation___,3_!0.........Distance to nearest lot iine_ _�_ �/ A Number of pits------f-------------Lining material-_- pC-k-----Size: Diameter-_-_ —-----------Depth____,27`�-_____________--__ d . Cesspool: Distance from nearest well-----------------Distance from foundation---------------.__..Lining material-----------._____-_-__--______-__--__. ❑ Size: Diameter--------------------------------- ----Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well--------------------------- Distance from nearest building_____-_-______--____-___________-_____--_. [] Distance to nearest lot line------------------ --------------------------------------------------------------------------------------------------------------------------- . Remodeling and/or repairing (describe):--------------------------------------------------------------------------------------------------------------------------------------------------------- n ----------- ---------------------"------------- ------------------------------------------------------------ -------------------;--------------------------------------------- -------------------------------------------- - . - ---------------------------------------"-------------------------------------------------------------------------------------------------------------------------------------- I I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, to Iawsp and r s an regulations of t e San Joaquin Local Health District. S (Signed) --------(Owner and/or Contractor) By:------------------------------------------- — --- {Title) (Plot plan, showing size of lot, location of system in relatio +o wells, buildings, etc., can be place on reverse side. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------- ----------------------- DATE------ -�------- ----------- REVIEWED BY ------- --------------------- ------ DATE------------ ----- BUILDING PERMIT ISSt.IED-------------------------------------------------------------- - t PATE--------------------------------- --------------------------- Alterations "---- ----- Alterations and/or recommendations:_______`_- _t�-__ �___ . `�'_,..__.___r -___ f%` - s._� _1_.___ - -_ . ----------- ----------------- ------------- - ------1 _(C� ----------------------------------------------------------------------------- ----------------------------------------------------------- ------- ------------------------"--------------------------------------------------- -------------------------------------------------------------•--------------------------------- ------------------------------------------------------------------------------------------------------------- FINAL INSPECTION BY:------ -----w-------- ----------------------- Date-- -------- -9 C1 �.�7- ---"---------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California F.P.E O.