22297 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. -- ------------------------------------------ ------------------------------------------------ - � -------------------- --------- (Complete,in Duplicate) Date Issued __f--�9 -.-_................... ...........- 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 d crbed. This application is made in compliance with County Ordinance No. 549. O JOB ADDRESS A D CATION --'r- - --- ------------------ . . �-- Owner's Name - j per! - - - -----------••----- ---•----- --------------- --- ----------------- ------------- Phone-------------------------------•---- Address----- -- 1Q-` - 1-6-- --- --- F �- Contractor's Name- -- -----n / t - -- -- ------------------ -------------- Phone Ph Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _,I--- Number of bedrooms _.Number of baths_Z__ Lot size _11r,1_0------- ---- ------------------- ------------ Water Supply: Public system ❑ Community system ❑ Private [[Depth to Water Table 16- ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ -- 1 Previous Application Made: [if yes,date-----------.------- 1 No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ { TYPE OF INSTALLATION AND SPECIFICATIONS: j (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ? N Septic Tank: - Distance from nearest well-----------------Distance from foundation--.-------------... Material --------------------------.____.------._- ❑ No. of compartments---------------- =-•- -.---Size-----•------------- ------- ---Liquid depth--------- ------- ------- Capacity-----.-..----- ------ Dispvsa field: Distance from nearest well.-.5."O!--.-Distance from foundation__A'9-...........Distance to nearest lot line----------------- Number -_`----------Number of lines ----------- .....Length of each line_- _-l`�-��'------ --�:------ Width offirench.-�--f------ --------- Type of filter material-_._.------r- --Depth of filter material----._111--.-. ....-Total length----_---9_e-_------------__-___---. Seep�e/Pit: `Distance to nearest well____-lOof ___-Distance fr undation_____ ��____ D Lance to nearest lot line_..S_.�__.__ Number of pits... -_._1...........Lining material__.__ -_t�f. Size: Diameter.....r `r..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_.--.-----.---..---------------------.-.-. ❑ J Distance to nearest lot line------- - --- ------------ -------------------------------------------------------------------- ........ ------------ Remodeling and/or repairing describe : -- _-•-_ �- ----------- .- - ;1 ----------------------•----------- ------- r -- --- ,-- ------------------------•----------------------------- --------------------------- --------------------------------------------- --- --- ------- ---- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State law a rules and regulations of the San Joaquin Local Health District. P�KA (Signed) ------ -------- ---------- . .---- -------------------------------------------------------- d/or Contractor __.. (Title) --------------------- -------------------------------------- (Plot plan, showing size of lot, location of system in relato o wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --- ----------------•- -------- ----- DATE__P-.4` -_------- ---------------------- REVIEWEDBY----------------------------------- ----- - - -------------- --------- ------ DATE----------------------------------------------------------- BUILDINGPERMIT ISSUER------- -- - , --------------------------------------------- - -- DATE--------- ---------- Alterations and/or recommendations:------------- -------- - ---------------------- ----------------------------.---------------------------------------------------------------- --------------------------------- ---------•------•------------- -- - - -------------- ...-------------------------- ------- ---- --------------------------------- FINAL INSPECTION BY---- - - ----- --- -- - --•.- - -• Dat .-;F' �--_-- SAN JOAQUIN LOCAL HEALTH DISTRICT E1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 20.5 West 9th Street i Stockton,California Lodi. California Manteca,California Tracy,California E.H.9 2M 1-67 Vanguard Press