19228 - Laserfiche WebLink

Home Browse Search

J_ FOR OFFICE USE: ------------ ---------- ------------- .---------. � y APPLICATION FOR SANITATION PERMIT Permit o. .. ... .._ -- ---------------- ------------------------------------- (Complete in Duplicate) fes. r �" Date issued ---- --- �--�-_�`� __ _ -- ------------- This Permit Ex fres 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct a d in all the work herein described. This application is made in compliance with County ante No. 549. Y�� i JOB ADDRESS ANp_LQeAjION----- l� / = �' j T - ----- ms �E -------- _3 _--' 1Owner's Name-------- --- ---��---------- ---------- -------------------------------- Phoni -c/- ' s �Address----_------------------ . - ----------------------------- �r Contractor's Name---------r~ % � 1 j -- .1 ----------------------- ----------------- Qhs---I---�� ❑ Installation will serve- Residence [Apartment House ❑ Commercial ❑ Trailer Court Motel Other Number of living units: -_./- Number of bedrooms ---2-.- Number of baths ----- Lot size ...... ------------------ Water Supply: Public system ❑ Community system ❑ Private Ei?-�epth to Water Table 0"9ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy 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 sewer is available-wi+hin 200 feet.]- ` -7 aterial G��, ,5" I Septic T Distance from nearest well_ ....Distance from foundation_ L?----- -.Mr---------- �� No. of compartments-----------a'-------.Size__ x- �� ------Liquid depth----�f�--------Capacity--'Op. --� --- m Disposal e d: Distance from nearest well_ _ _-'_Distance from foundation-f r --.Distance to nearest lot line----------- ' [ Number of lines_____---fir ____ ____ _____Length of each line...... --~---`, 0.Width of trench-_-_ -`-------.__.___. m Type of filter material--- lpD ---Depth of filter material -_14* Total length___/At9___`-----------------_-_ '� See it; Dis#ante to nearest well Number fr m foundation_tQ---__-----Distance to nearest lot line_./. Number of Fts._---_ --- -Linin material--�'� Size: Diameter--- Depth_...�'��__-_---___.._ -� p "` 9 Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material---------------.---_____._--_---___. ❑ Size: Diameter-------------------- ----------------De th--------------------- ------------------ -Liquid Capacity gals. v� r Privy: Distance from nearest well-----___---------------------------- -----------.-Distance from nearest building----------------------------------------- ❑ Distance to nearest lot line------- ---------------------- -------------------------------------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe):_--_ - d-.------. --------------------------------------------------------------------------------------------- -- ---------------- -- ----- - ------ -------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------ ----- 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State I les and regulations of the San Joaquin Local Health District. (Signed) ----------- �/_ ---------- ---------- _ ------------------- --- -- wnRr nd/or Contractor) 9 } ------(Title)-- By: i ----------•--------------- ---- ------- *�- ----------------------------- (Plot -------------------- ---- - (Plot plan, showing size o ot, loca ion of syst in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY___ - DATE___- ---- __"G - �1=z ---------- ----------------- REVIEWEDBY-------------------------------- ---------------------------- DATE----- ----------------------- ----------------------------- BUILDING PERMIT ISSUED------------------ - DAT It and/or recommendations:---___-. / ' f` . ------d'�c�- -------- ;,. 0.1------t;�11 - -- ----------- --�r 3 - ' -------- ------=- --------- ----- ---------- �-0- - --------- FINAL INSPECTION BY:..._- Date--------- 71-.�- - /�o-S ------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazehon Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California i F.a.co. 1