20380 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: - -------------.-- APPLICATION FOR SANITATION PERMIT Permit No. - 1x,23-_s'® - ,. (Co p efe' iri Duplicate) ---------- --- This Permit Ex fres 1 Year From Date Issued Date issued �5..-3/-'. � 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.-k ;-O_..3._9---el----/--!✓...._:-- _ Owners Name..--- _____ p �/'� --------------- Phone------------------------- Address------------ f' aS_• 4.__a%r� rr w ----- - -- - - --------------•--- Contractor's Name ---- -----7 ---------------------•--- ----- Phone----------------------------------- - -- ------ Installation will serve: Residence [4-iApartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ ; Number of living units: _...f-. Number of bedrooms -Z-. Number of baths __f.... Lot size .--_ --? •--------------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Tableft. Character of soil to a depth of 3 feet: Sand ❑ Gravel p Sandy Loam ❑ Clay Loam ❑ Clay [❑ Adobe E!['Flardpan ❑ Previous Application Made: (If yes,date:___________________) No flr-�New Construction: Yes n--No ❑ PHA/VA: Yes ❑ No [t— TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank:or cesspool permitted if public sewer is avdilable within 200 feet.) € Septic Tank: Distance from nearest.wet----------_Distance from foundation./P._.----------Material-----J _- No. of compartments___---&________________Size...,--c3_. LS `�-•-'-.-Liquid depth..___--.._4.....____-Capacity-----S"-�c??- Disposal Field: Distance from nearest welt--- ----------Distance from foundation./p-.`.........Distance to nearest lot line r.,.U._.--- ;. ❑— Number of lines-----------------_-..._..__--.-_Length of each line_____T,P---_.------..___.-Width of trench__-- T �--`4------- p , ype or` iter material,... _ _ Depth of filter mater al.-.% .`.._.____..Total length_-....2.1------------------------------ 'Seepage '..............:.......... 'Seepage Pit: Distance to nearest well------!',-----------Distance froi-n foundation--- _jc>-----------Distance to near. 's:t•:lot line.-,.5'7..-/___-.. P ...__Linin material-��/r----__Size: Diameter------- ".. De to ❑� Number of pits-----L- g Cesspool: Distance from nearest well-----------------Distance from foun _ . dation................. Lining material---...._.....-...__._ ----- ❑ Size,Diameter-------------------------------------Depth------------------------------------ ---------------Liquid Capacityr.-------------------------gals. f . Privy: Distance from nearest well..........................._._...______----i._._Distance from nearest building--_--�.._:_- ------ - W ❑ Distance to nearest.lot line----- ------------- Remodeling ---------Remodeling and/or repairing {describe):..__..___--- ----- ----------- -------- ------------------------------------------••------------------------------- =--------------------------- ------------------------------•------ -------------------------------------------------------------------------------- ---- ---------------------------------------------------------------------- ------------------------------------ ------------------------------------ -------------------------------------------------------------------------------------------------------•------------------------------ I hereby certify that I have prepared this application and +hat the work will be done in accordance with San Joaquin County ordinance$, State law } aryl rules and re lation of the San Joaquin Local-Health District. (Signed) -------------------------- --------------(Owner and/or Contractor) ~ By:------------------------------------------------------------------ ------------i------------- --------------------------------------(Title)-------;-:.---------- -------- - ---------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be place&on reverse side). ,l FOR DEPARTMENT USE ONLY F { j APPLICATION ACCEPTED BY ------ DATE------ ------------------- -- REVIEWED BY-------------------------J------------------- --- --------------------------------------------------------------------------.- DATE = ------------------------------------- BUILDING PERMIT ISSUED------------------------------------------------------------ ----- ----------- DATE Alterations and/or recommendations- ----------------------- ---------------------------•-----------------------------------------------------------------------•------------ - r - - - --- ------------ ---------- -------- ------------- -- -------------------------------------------- FINAL INSPECTION BY:----------- ©ate -----=.5 SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E,Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.C i1.