14818 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. ,! .... .. ..... --------------------------------------------------- -- - (Complete in Duplicated 0Date 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„wth County Ordinance-�No. 549. L �� ® © f ? p :_JOBADDRESS AND LOCATION----- Owner's Name------- -� ��► -y�----------------------------------- ---------------- Phone..L'-a`1.._ _-.��_�u' .. Address-----' ..._. . ...r--- r��:`3 ;<-_..L ..--- { Contractor's Name---- ------- -------- �1'� SAA_ 11_w---------------------------------------------------•---- Phone--- `==........................... Installation will serve: Residence ❑ Apa4ment House [j Commercial�,Q Trailer Court El Motel [:] Other ®� $ Number of diving units: -------- Ndmber of bedrooms -------- Number o- ,, Lot size ______________--____-_,__._.....-------______--_-__-_-------_ Water Supply: Public system ❑ Community system ❑ Private- }I depth to Water Table __` _._ ft. 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: r (No septic tank or cesspool permitted if public sewer isava lable within 200 festa. Septic Tank: Distance from nearest Distance from foundation_____i,_:L>_-__-___.Materiel`1�_r�-_ ....Cdh _ }c ❑ No. ofcompartments_________'______._Size__ '..z�,__�1__X ."___Liqu`id'dep+h_". `. -----Capacity_.E.0_.�_.%e,I CO Disposal Field: Distance fromnearest well_,��'___�r-_Dist once from foundation.L1.0 Distance to nearest lot line----=...... ice_ _Length of each line_.rICS{_-- -_-9ohf_.Width of french--. ................. r' ®, ;A Number of lines_____Z-...,.__.' ._____-_-._ g ( Type of"filter material.-raze -,-------Depth of filter material:_P�_1_S__"_____-Total length______ ..•..................... ~" > ; Saepage Pit: Disfance to nearest well______________________Distance from found-tion......... ..........Distance to nearest lot line--------.__...... 'i ❑ Number,of pits---------------------Lining material-:•--- -Size: Diameter----.--------------_- Depth---------.-----------------------i Cesspool: :!P- Distance from nearest well_________________Distance from foundation_-- ___''_. _____.Lining material..-____-----____________-___-__--_--- ❑ Sizer Diameter Depths -- -- 1 Liquid Ca acifY ----•-----.gals.' Privy: t Distance from nearest well-_______________________ ---------Distance from-nearest building........;--_-_---__----------_____.____._- �7 Distance,to nearest lof-.line--------- ------------- -----1=---- _ --.------------.-----•----------- ' Remodeling and/or repairing (d scribe): ----------------------------�--------=-------------•----------- i -------------------_----------...•-•...... ---------- -••-------------•-•----•--------•----...--------------- _ ..------------------------------------------ ... ._... - , ......... __... ' -------------------------------------------------------- -------------------------------------------------- --------------------- --------•----------- ----- ---- -------'t--- - hereby certify that I have prepared this application and that the work wall..beTdone in accordance ce w h ,San Joaquin County ordinances fa law red rules and regulations of the San Joaquin Local Health District. { (Signed) - - ;------ (Owner and/or Contractor) f _ 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 APPLICATION ACCEPTED BY----d-----_ ---------------------------------------------------------------- DATE- -CvZ -- ------- ------------------------ REVIEWEDBY----------------------_-------------------- ----------------------------- -------------------------------------------------- DATE----------- --•-•--........................................ BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------------------------- DATE......................----•------------•-------_--- Alterationsand/or recommendations--------- --------------------------------------------•-------------------------•-----•---•-------•----------..............-•--•-------------------------------- ... ...........................•-----------------------------------------• - ----------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------ •-----•---------.-------------•---•---------------------------------------------------------------------------------......-•---------------------.----•------------------------------- 4> FINAL INSPECTION BY:---c--' �--- � - --- --- •� ----------------- Date_- -Q--- ------�- -----------Z------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 south American Strut 300 West Oak street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California # Manteca,California Tracy,California EB 9 NEVIBEo B-59 ZM 8-6t ATLAS~� Jam,