20376 - Laserfiche WebLink

Home Browse Search

FOROFFICE USE; ---------------- �� r --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. . ................ (Complete in Duplicate) ----------------------- This Permit Expires 1 Year From Date Issued Date Issued aG9 -oclo--of' Application is hereby made-to the San Joaquin Local Health District for a permit to construct and install the-work1erpin described. This.yplication is made in compliant County Ordinan e No. 549. J 't � T JOB ADDRESS At LO ATION__:- V�3►s a .0 i-- ------- - -•-- ------ .( �'C« .E -- ` f' r44 41 ` r Owner's Name------- - ------cwt------------------------- Phone.. 4tP Address---------------------0� ------ i- --- -- - - -- - r - d-d. ........ ............ Contractor's Nam ------------ ---------------------- Phone--44-46-tD i Ki Installation will serve: Residencepartment House ❑ Commercial ❑ Trailer Court ❑ Motel E] Other E]Number of living units: __ ____ umber o e rooms -------- Number of baths ________ Lot size Water Supply: Public system ❑ Community system ❑ Privat Depth to Water Table ---_ ft. Character of soil to a depth of 3 feet: Sand [] Gravel ElSand Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date_---_-.- ) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: {No septic tank or cesspool permitted if public se�s available within 200 feet. Septic Tank: Distance from nearest ell/ 70. Distan fro xfou ion-_-__ _______..Mate 1140 No. of compartments-- ------------_----Size. _11_ -Liquid depth.- --------Capacity_____� iDisposal Field: Distance from ne well_1�______ Distance from frin n__,/_ istance to nearest lot one__ Number of lines_ - Width of trent s r, Length ofk . Type of filter materk- _ p g _-. __De Depth of filter ma rial__` _./!--_--Total length Seepage Pit: Distance to nearest well________________ ____Distance from foundation--------------------Distance to nearest lot line_____.___________ ❑ Number of pits----------------------Lining material--------------------_- Size: Diameter---------.-.----- -----Depth--------------------------_ 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-_-._-_-____--_____________.____._.-_. F1 Distance to nearest lot line------ --------------------`---------- ------------------------------------------------------------------------------------------- Remodeling and/or re airing (describe) -- -- ------------ --- ----- -----------•------------------------------------------------------------------ --- ------------------ __ ------------- - r+r..G` ------------------------------------------------------------------------- ------------------------------------ ---•-------I------------------------------------------------------------------------------------------------------------------------ --- ---- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, S to la s, and ruled regulations a Sen Joaquin Local Health Dis t. 5i ne , ----- ---��C--^ or Contractor [ g -(�! ) 6 • . --------(Title)---------- -------------- ------ - ----- (Plot plan, showing size of lot, location of sysfem in relati to wells, buildings tc., can be placed on reverse side). y FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- = d --------------- ------------------------------------------------ DATE---3- 1 --------------- ----------------- REVIEWEDBY-------------------------------- ------------------------------------- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED------- --------- --------------------------- ------ DAT Alterations and/or recommendations __- ---- ----- - -- - e-------- ----- --------- ---------------------- ---------------------------------------------------------------------------------------•------------------------------------- -------- - •--------- ------------- ------------- --------------------------------------- - --------------------------------------------------------------------------------------------- --------- ------------------- -------- - ---- ---- ------------------------------ ---- ----------------------- - ------- --------------------------------------- ---------------------------------------------------- ---------------------------------------- 9 FINAL INSPECTION BY: ----- - ---------- Date �.. 6 .--.-... - CC_.•�� SAN JOAQUIN LOCAL HEALTH DISTRICT 1801 E.Hazelton Ave. 300 West dale Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CC.