19200 - Laserfiche WebLink

Home Browse Search

AW FOR OFFICE USE: .. �M —------------- APPLICATION FOR SANITATION PERMIT Permit No. ...... G/x/9 ------ (Complete in Duplicate) Date Issued ----------------------_------.--__-._____„_- finis Permit Expires 1_Year,.From Date Issued Application isIhereby 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. A,i / ; OP? Lj- JOB ADDRESS AND LOCATION j tea u--- 1/ ------------------------ y`f ',- �' �p --------- Phone.---• J � � ----- Owner's Name. ' --- --�Ii�ssc �l- � _ --� -------------------------------------------- Phone_ -=---------- - �7— - Contractor's Name = s Ir fl---------------- ------------------- ------------------------- ------------ ---- Phone..- _y_-- � _ r Installation will serve: Residence I[ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --I____ Number of bedrooms ---- Number of baths __;L-._ Lot size -------4__c------ ------_____________ i Water Supply: Public system ❑ Community system ❑ Private [Tj Depth to Water Table k4i_ ft. Character of soil to a depth of 3 feet: Sand p Gravel ❑ Sandy Loam ❑ Clay Loam (] Clay [❑ Adobe E3' Hardpan ❑ Previous Application Made: Ilf yes,date-----------------...) No E' New Construction: Yes E"No ❑ FHA/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--.1-P!_____Distance from foundation----1 - -____.Material__Cf,'-_'� _ - --_______ No. of compartments-----�----- Size 5 .. -- Liquid depth y! ---------- Capacity Z'L"4�,___-_____ - Disposal Field: Distance from nearest well-.j7P_ ......Distance from foundation----M_..........Distance to nearest lot IiA__7 ----------- ❑" Number of lines________Z:_-_-_____________ _____Length of each line------ 'I�t- Width of french_-__--_K__-____---------------- Type of filter material------ -_Depth of filter material -__!_cf..._........Total length--------/-3 r pp�� Seepage Pit: Distance to nearest we '00-F Distance from foundation----f_�---------Distance to nearest lot line-._,S_.._______ a Q Number of pits--------2-----------Lining material----Ra&_k --.Size: Diameter....3.3_°--------Depth------- -------------- � Cesspool: Distance from nearest well-----------------Distance from foundation.-.---- ------------Lining material__-_.-__-_________----------_-_____ - Size: Diameter------ --------------------------------Depth----------- -------- - - ---------------------- - Liquid Capacity----- --------------------ga s. �ry Privy: Dis an nearest well---s.±._----------- ---_____--._---__------Distance from nearest building------------------------------------------ D --.-____-_----------________-_--_-__--. �l '•' ❑ Distance to nearest o - - ---- ------ 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 (p ordinances, State laws, and rules and regulations of Joaquin Local Health District. (Signed)------------- -------- --- ---- ------------------- --- -----------------------------------(Owner and/or Contractor) By:--------- ------------------------------------------------------------------------------------(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 APPLICAT7BY CCEPTED BY-- ---------�------------------ ---------------------- DATE--------�� Q -- REVIEWED ----------------------------- -- ----------------------- - ------- --- ---------- ---- - ------------- ----- DATE---.-.-:.-- ---_----- - -------------•- --------------- BUILDING PERMIT ISSUED------------------------- --- ----�- --- DATE----- --------------------------- ----------- -------------- Alterations and/or recommendations:____. - -� -------------------------------------------------------------- -------------------------------------- ------------------------------------------------------------------------------------------------------ ------------------------ FINAL INSPECTION BY:...... Date-- -- - - lJ--------------------------- - SAN JOAQUIN LOCAL HEALTH DISTRI----T 1601 E.Noxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P-C a. t