22524 - Laserfiche WebLink

Home Browse Search

r FOR OFFICE USE: ----------- ----- ---------------I--------------t_._... ------ - - -- ----------- APPLICATION FOR SANITATION PERMIT Permit No. -------------------- --- -- (Complete-in Duplicate) ✓� This Permit Expires 1 Year From Date Issued 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 with County Ordinance No. 549. ��1 �. JOB ADDRESS AND OCATION._(� _Clh�.✓-- ` - '�P " 'U------------------------------------------------------------------ Owner's Name... --- -- ---•------- ----- - a - -------------------------- --------------- Phone Address ��. ti� ------------ - Contractor's Name--- ---------- ----- --- ---- --- Phone---- ---•--------------_------- Installation will serve: Residence In/Apartment House ❑ Commercial ❑ t Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __ 1.. Number of bedrooms __,?-_Number o . baths I.... Lot size ------ -------------------------------- Water Supply: Public system ElCommunity system El Private epth to Water Table ------ _ ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑; Clay Loam ❑ Clay dobe ❑ Hardpan ❑ Previous Application Made: (If yes,dote_-_.-------.------- ) 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 within 200 feet.) Septic Tank: Distance from nearest weal------------- Distance from foundation------------------- Material -------------------._..____._-_-.._--.....____- I ❑ No. of compartments---------- ---------------Size---------- --=------ -----------Liquid depjh--------- ------- --------Capacity----- - ------------- Dispos Field: Distarice from nearest well..... Distance from foundation-----f B..........Distance to nearest lot line----------------- pe, y .._Length of each line__.___ .............Width of trench___-__..._------_--_-_-- Number of lines.--------- ----------------- �.� d Type of filter materiai._....5___R_-___-__Depth of filter material-----lrl__.---------Total length-.-._ ❑ is e------------------_------ rline . \Seepage Pit: Distance-i-o;nearest well._._.................Distance from foundation to nearest lot line__-__-..-_--_--_ of pts--- --.__ ------- 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 ❑ Distance to nearest lot line_--------------------------- "` Remodeling and/or repairing-(describe):---- -------- t ------------------------------------ ----------- ----------------- -----------------------: -------- ------------''---••------------------------------------------------------------------------------------- -- ________________"-_..__....___ _.__-_ - _.___.___-__•- __. _.------ ----------------- -•----------------------------------------------------------------------------------....__-_----_-_--_--------- 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 , and rules and regulations of the San Joaquin Local Health District. (Signed)----------=----- ----- -•-------- R ---`--- - -�--•- _=-------------- -------- --------- -- ----- . "an -d/or Contractor) - --- ---------------- (Title) ' . - :.- ---- ------------------ " By::------------ ----- -------------- -- --- - ------ (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__ - ,,--.-i -' jj --- ---------- ----------- REVIEWED DATE--f REVIEWEDBY-------------------------------------------- - ----------------------------- ------------------ DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED-------- -- ----------------------------------------------------------------------- ------------------ DATE--------------------------------------------------------- Alterationsand/or recommendations----------------- -------- ---------- ------- ---- ----------- - ------------------------------------------------- ---------------------•--------- ------- ---------- --------------------------- ----------- -------------------• - --------------------------- •------------ -------------------•----------------------- ------------- ---------------- ---------------------- ---- -------------------------------- I -------------- - --------------------------------- -... .................. -------------- - ---- ------------------------------------------ ------------- ------------------ -------------------------------------------- FINAL INSPECTION ---------- Date.....//-4P-74.7-- --------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hoiellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street I Stockton,California Lodi, California Manteca, California Tracy,California E.H.9 2M 1.67 Vanguard Press