18988 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: .�^ f -- Permit No. -.(-�-9 ----- -------- ------- ------ ---- � APPLICATION FOR SANITATION PERMIT ----------------- ------------------- ------------ (Complete S ------------ ------------------ ---- Com lete in Duplicate) Date Issued _ _ This Permit Expires 1 Year From Date Issued Application -- - - -- --------- ----_hereby made t-- the San Joaquin Local Health District for a permit,o construct,and install the work herein described. This application is made in compliance with County Ordinance No. Aj . `«}3 Cc-F-✓4r. '774( S Ir RT'. ---A ,<--- ----- )----' JOB ADDRESS AND LOCATION__s- Owner's Name.... __ 7 Address --�--------j f Contractor's Name________ _________ Installation will serve: Residence Er, Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ r Number of living units: _/......Number of bedrooms __ _ Number of baths I--__ Lot size -- 5- Water --------- - --- Water Supply: Public system ❑ Community system ❑ Private Ems-Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑' Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 9—Hardpan ❑ Previous Application Made: (If yes,date--------------- ----) No ®- New Construction: Yes ❑ No R- FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) el r_--__-Distances rom foundation---�°______-_-MatelaL__/ercf 'a-de - ______ _ Septic Tank: Distance from nearest well__:1_°__-- X No. of compartments--------4--------- Disposal ------- Size x�r Ligwd depth - capacity--- X apacity ` Dis osal Field: Distance from nearest well -------Distance from foundation---�!`------------Distance to nearest lot line_________________ p Number of lines-_------�-----------------------Length of each line__ + _ y '- ------Width of trench.----Z..................-- ---------- �r - - fit' Type of filter material__�d<k__ ---Depth of filter material-__fd'---__-_--_--Total length----tkJ___.-------------------------- e Seepage Pit: Distance to nearest well_-S c______-_----Distance from foundation__-a---------- .Distance to nearest lot line---_ - - P - ------ -------- �— Number of pits....../----________Lining material---9qC�------Size: Diameter__';�X-�_o-.x`r-__De th_._-.-- Cesspool: Distance from nearest well_---------------Distance from foundation--------------------Lining material__-__-__------------------------------ Size: ________ --__-_-____---_____- 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):------------- ------------------------------------------- ----------------------------------------------------------- ----------------------------•--------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances. State j11awsnd rules and regula+ions of the San Joaquin Local Health District. (Signed)------------- - � --- ----' -----'' ---t--- - ------------------------------------ -- ---- --- ----------- Owner and/or Contractor) By:------ ------(Title)-- ------------ -------- -- - ------- --- -------- (Plot plan, showing size o lot, Iocation of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------- - ----------- DATE-------------------------------------------------------- -- REVIEWED ----------------------------- REVIEWED BY-- ------------------------------ -------- ----------- ------------ -------- ------------- --------•---- ------------ DATE--------------------------------------------------- -------- BUILDINGPERMIT ISSUED-------------------------------------------------------------.--------------------------------------- DATE------ ------------------------------------------------------ Alterations and/or recommendations:-------------- --------_......._ ------ ----------~ ---------' -------------------------•-------------------•--------------- --- --------------- -------------- ---------•-- ---- ----------------------------- ---- - -- - --- ----------------•------------------- -------------•----------------------------------------- -------------------------------- --------�-------------- FINAL INSPECTION BY:.. -_ .--- +' --- Date---------- ----r�J-----,--- — �------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 4th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CC. ._� -