16481 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE --------- APPLICATION FOR SANITATION PERMIT Permit No. ._��..,...t�. ----------------------- --"---------------------- -------- (Complete in Duplicate) �d/ -=.-- -- This Permit Expires I Year From Date Issued Date Issued ------ r Application is hereby made to the San Joaquin .Local Healfh District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. ��; 2-07 �3�. Oy JOB ADDRESS l t '��$5S°s',.,�'sc:4c.dy'J"j1 r✓t�..o7?4;- , AND LOC ATlON -�' �dQ - -0 X9v�42L�i .=0` .fa �rfrY `JL Owners Name_______. - a, ------ --•=---'-• -- - --------- ----------------------------------------------------- ------------------- -- - !.. Phone------------------- Address--------� � ........ p - e ----------------- - ----------•-------------------------------•--- ...... Contractor's Name_ - .. �.] --•----------• - Phone Installation will serve: ResidenceApartment House ❑ Commercial .❑ Trailer Court ❑ Motel ❑ Other ❑ Number of'living unit's: _____ Number of bedrooms .,3_.: Number of.baths._1____ Lot size _7_4---4J1/L� ----------•----------------•------- Water Supply: Public system ❑ Community system ❑ Private M,-Qepth to Water Table Z-CU ft. ' Character'of soil to a de th of 3 feet: Sand Gravel Sand Loam Clay Loam Clay Adobe Hardpan P k ❑ ❑ Y ❑ Y ❑ Y ❑ P ❑ Previous Application Made:[!. {If yes,date------------------_--I No [ New-Construction: Yes 'Er--No ❑ FHA/VA: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: V� (No septic tank or cesspool permitted if public sewer is available.within 200 feet.) Septic Tank: Distance'-from nearest well7�________Distance from foundationlD-------------Ma serial- _-_________.-- ' - - _______________ Liquid de th � P Y No. of eom artments_ b 1 P = Size__XL3=1r_�. �! -_ p_,--� -"-------- -----.Capacity...�--- •• Disposal .ieid: Distance from neares well..:7cS-___-Distance from foundation --_.Distance to nearest lot kne.4S_____--.___ Number lof lines____. - F N ------------------Length of each line---Z "---------------_.Width of trench ___•------"----- ----- Type of.':filter..material___f_o�---------Depth.of:filter,material:_� `__________.Total length----10-6. � Seepage Pit: D1stancel to nearest well-/00--.__t'-._Distance from foundationJ4_"__.__.Distance to nearest lot line___-_______ Number!of pits------ G k--. ` r ,i p ,._________Lining material--,- ---_ Size: Diameter____��..-'_.____Depth_.__�� ______________ Cesspool: Distance) from nearest wel ----------------- from foundation-,-------------.___.Lining material___._--________.________ __________. ❑ Size: Diameter--------------------------------------Depth----- ------------------- --------------------------- Liquid Capacity-----------------------=---gals. Privy: Distance from nearest well-i- ------------------------ ---------.--------- ---Distance from nearest-building.___-...______----___________ ❑ Distance'to nearest lot line------------------=--------------- --------------------------------•- I Remodeling and/or repairing (describe)--------------- ------------------------------------------------------------ , --------------•--------------- -------•--•------ -----------------------------------------------4-------------------------------------- ----- -------- ------------F----,`-----------•----------------•-------- --------...-----------------------------------------------------------------------------------•-----"----------------------------------- I hereby certify thatAio application and that the work will be done in accordance with San Joaquin County ordinances, State laws, anions f the San Joaquin Local Health District. (Signed} = -- -----" " " [Owner and/or Contractor) -"(Plot plan, showingsize oem.in relation,to.wells,'b'uildings, etc., can be placed on reverse side]. 1 FOR DEPARTMENT USE.ONLY APPLICATION ACCEPTED BY----------------- _" k -----~��-------------- = , `"=---_----- "------------------- DATE------" REVIEWED BY .............s_-----------------•--------------------- =-r""--------------------------- DATE------ ---------- BUILDING PERMIT ISSUED---------- ---------= `. -= 'V'-' DATE Alterations and -r " ----------------- - / --------------" ----------- F/ 5 --- - -- --------------- ----------------- ------ ----- ----------------- --- - ------" - " '� FINAL INSPECTION BY:.-`-----------C ��-r 09CC e--------------------- Date-.---- r SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED B-59 3M 3-'E3 f.R.CO.