20613 - Laserfiche WebLink

Home Browse Search

rUK cif-1 lK_L USE: T- -------------- APPLICATION FOR SANITATION PERMIT Permit No. -.11�D _l -------------------------------------------------------- (Complefe in Duplicate) ----""" ----- ------- ------------- I This Permit Expires 1 Year From Date Issued Date Issued K"7:�e� 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. JOB ADDRESS AND LOCATION lY ✓ �iPP am;- ----------------------- .. ------ Owners Name �, ---_ ------- -- " --------------------------------- Address --------------•---- ---------- ... - ----------- Phone. Address----•------- ��" ------ -------------- Contractor's, Name______-_ •- _ - ----� y-. ._ _ �„ �--- -- ---•----------------•------•-----•----------• _ f-------- - Phone Installation will serve: Residence Apartment ouse t, i t ❑ Commercial ❑ Trailer Court ❑ Mote! ❑ Other ❑ Number of{living unitsc--- Number of bedroom �,/ sNumber f baths _/._- Lot size ____ ------------ Water Supply: Public s`ste ------------- _ m - PPY y ❑ Community system ❑ ;,Private Depth to Water Table ........ ft. Character of soil to a depth of 3'feef: Sand^❑ Gravel ❑ Sandy Loam ❑. ClayLoam ❑ Clay ❑ Adobe❑ Hardpan Previous Application Made: ' {!f yes,dpte-_______ _ __) No ❑ New Construction: Yes Eli `Noa❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic ank: Distance from nearest we%� _ Distance Distance f.ramefoundation_"_fes__.___._".Ma�t�eMaterial- No. of compartments---------�� Liquid depth -/ i --------------- --------- - - y ---------Capacity.-p y- _ Dispos Field: Distance from nearest well �--,_Distance from foundation....AP_ -_""_.Distance to nearest lot Lina ___""" f Number of lines___.______ Length of each line_____.__ . � � of french.2-ii' Width ..- . Type of filter material-------�� -_,_---_-_Depth of filter material-__/f----- -----Total length----/�_---__ Seep e Pit: Distance to nearest well----af_Or /-----Distance from oundation----IA_f`_____.Di`sta-"----.Distance to nearest lot line____- --"�----• Number of its____--_ materialr _.-__Size: Diameter___.__ p ,�..---___Lining ___-_- �� 1_ t l .S� 7"�---------Depth--�"------------------------ Cesspool: Distance from nearest well Distance from foundation__________-. " - __ ------.Lining material-------------------------- El --•_--------� Size: Diameter_—--------------------- ----------Depth--------------- ----------------------------- -- ----- ---- --- ------=------Liquid CapacitY------------------ Privy: "'�----gals. Distance from nearest well-____________________ - ------------ - _____.____-"Distance from nearest building El Distance to nearest lot line------ --------------------------------------------------------------- 9 ---------- ---- -------- --------------------- -------- Remodeling and/or repairing {describe):__- - cr [ ----------- --------- ---------------------------------------------------- ------------------------------ --------------------- _- - --- --------- I hereby certify that I have prepared this application and thaf the work will be done in accordance with San Joaquin County ordinances, State laws,rnq rules and regulations of the San Joaquin Local Health District. (Signed)---------- ----- -- ---- -----Q4__tA� ----- ------- --------- --------- --------- ---------------- ---- - nd/or Contractor] BY --- Tale (Plot plan, showing size of lot, location of system in relatio to wells, buildings, etc., can be placed on reverse side). --------------------------- - ----------- ----- --- ----- FOR DEPARTMENT USE ONLY . APPLICATION ACCEPTED BY_"__ ------------------I DATE_"J:"".--/.3 '�G REVIEWED BY ----- DATE---------------------------- BUILDING PERMIT ISSUED------------ ------------ _ ___ __ ______ _ ------•----------------- ----- -------------- ----------- - -------------------- DATE Alterations and/or recommendations: _-_----------------- - •------------------ ------------------------ -------------- - ----------------------------------------------------- FINAL INSPECTION BY------------ --------- - 09 ---------"__--- Date"_.-`�_l __-ls�a . SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazolton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California 7ra[y,California