22462 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: --------------- --- ------- ------- APPLICATION FOR-SANITATION PERMIT Permit No. a - ------------------------ -------- ----------- -- -------- —C7 (Complete in Duplicate) Date issued �Q-.'----------• --------------------------- This Permit Expires 1 Year From Date Issue -...-- d. Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work here's descrbe This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION....._____________......E�.�.��---- --------•------------------------- Phone �� Owner's Name --��R----- 1�'-1•-•-�K� --- ----------- --------- -------------------------------------� _ .�_`�__�------ ------•---- Address---------------------------------------------------------------------------- Phone----------------------------------- --------------------- Contractor's Name-------- k1- _-----------------•------------------------•---_- :�___- --. Installation will serve: Residence 9 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __t--.- Number of bedrooms -3--- Number of baths __ ---- Lot size --- -------- -------- ------------------------------------- Water ----•---- ------- ---------•--------Water Supply: Public system U? Community system ❑ Private ❑ Depth to Water Table -------- ft. Adobe Hardpan ❑ Character of soil to a depth of 3 feet: Sand E] Grave4 ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Previous Application Made: (If yes,date._------------ --) No V New Construction: Yes ❑ No FHA/VA: Yes E] No,9 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__..--_----_..-_------_----_--_-_-_---_---___-. Nfj< \Hf* No. of compartments--- - --------------------Size.------------------------- -----Liquid depth.---------- --------------Capacity---------------------- Disposal Fieid: Distance from nearest well-----------------Distance from foundation--------.---------..Distance to nearest lot line---------- - jc\Sj\mob Number of lines-------- ------------ -- ----Length of each line----- Width of trench------0-- -. Type of filter material-------------------------Depth of filter material----------------------Total length--------------------------- i Distance to nearest wel4_---MPI.--__ Distance from foundation--- ----Distance to nearest lot line---- �r �' : 6 19 (_ID- Depth--- -1Q Sut1\F -- Number. of --`-------------Lining materialZ��-.�O�C-Size: Diameter. th Cesspool: Distance from nearest welL________________Distence from foundation.._-_:__..__-___.__.L'sning material---____._.-__--_...____-____.___.__ Li uid Capacity gals. ❑ --------------------- 9 p Y - Size: Diameter-------------- -----------------------Depth------- - ---------- ------ Privy: Distance from nearest well _--__-.-_--------------------------------------Distance from nearest building----------------------------------------- ` Distance to nearest lot Iine--------------------------------------------- -------- ------------------------------------------ -----•------------- Remodeling and/or repairing (describe):------------------------------------- --------------- -------------------•-------------------------------------------------------------------- --------------------------------------------------- --------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. 5i ned --------- --------- ----------- (Owner and/or Contractor) ( g (Title)- -------- - - (Plot plan, sho tng size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTEDB -- DATE.---- �r �'b�-------------- -------------- DATE REVIEWED BY--------------------------------- ----- - -L-------------------- ------ DATE----------------------------------------------- ----------- BUILDINGPERMIT ISSUED---------------------------------------------------------------- ------------------ Alterations and/or recommendations:_----------- -------- ------------------- ---- --------------------------------- --- ----------------- 6 FINAL INSPECTION BY:_ --------- Date......Vk7a.-On----- ---------- ---------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Ha:slton Ave. 300 West Oak street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.co.