20531 - Laserfiche WebLink

Home Browse Search

„ FOR USE: -------- -------- --- % �iit No. - 0� - J'�' APPLICATION FOR SANITATION PERMIT Pct 7 --------- --------------- -- ----------------------- (Complete in Duplicate) --- This Permit Expires i 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. E This application is madr e incompliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION----. .67 Owner's NamefQ _�.' ----- Qa -_ -,' 45---�-------tl-----l---�---,r----- ---------- ------------- Address - - 1------•-, --- ----- .. .�-- •�-------------- --- ------------------------------ --P--h--v--n-e-------,------------ G!•a -,---- + -------------- Contractor's Name------ � --- Installation will serve: Residence Apartment House ❑ Commercial [] Trailer Court ❑ Motel ❑' Other ❑ '� Number of living units: ---/-- Numbe`r of bedrooms „ ___ Number of baths _-/--- Lot size -__/ !2_X_�-- r ----`.-_-_.----_ Water Supply: Public;system [?�- Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam a Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date........... ........I No Z, New Construction: Yes ❑ No a FNA/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 well----------- Distance from foundation--------------------Material'.----___._--...----._.--------------_- ---------- ❑ No. of compartments-------------------------Size--------------------------------Liquid depth---------- --------------Capacity------------ ------ Disposal Field: Distance from nearest well Distance from foundation-.-_ _.---..Distance to nearest lot line-.-�__�__ G f�f Number of lines---------l_.�-.,..f. --------Length of each line----�"Q-_------- -_Width of trench-----.2-� ” Type of filter material- /P��j _Depth of filter material--/g. length-._�'V__--------------------- -----_ Seepage,Pit: Distance to nearest Well-............... ---Distance from foundation-------------------.Distance to nearest lot line-------_--------- ❑ Number of pits------------------.--Lining material-----------------------Size: Diameter-----------------------Depth--------------------------------- O 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}:_._.---.. - �'_ r"l~Tc ------------------------ j/� -------------------------------------- ----- -- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------ ----- - --- - - -- - --------- - - --- -- -- ------ - --- ------ -- - - -- - (hereby certify that I have prepared this application a t the work will be done in accordance with San Joaquin County ordinances, State laws' and rules and regulations of t S n Joaquin Local Health District. t (Signed)----------- ----- - ' /S/ !--: [ "'S� /- . _ ner nd/or Contractor} By:------ --------------------------- -------------------------------------------------------------- -----(Title)-- (Plot plan, showing size of lot, locat' n of system in relation to wells,,buildins, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------ ------- DATE-- -- ------------ --.- -- - ------------------- ------- REVIEWED E S - --------------- ---------------------------------------------. DATE---------------------- ------------------ --------------------BUILDING PERMIT IS -------•-------------------------------• ---------------------- -- DATE------------------ Alter0ions and/or recommendations-------------------- ------------------ �f - --- ------ ------ --------------------'� - �xsp` FINAL INSPECTION BY:..--- ---------------------------------------- Date------- = 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.cn.