21026 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE:" r G� APPLICATION FOR SANITATION PERMIT Permit No. � ---------- - -------- -------- ------------------ - !_...-...-. ------------------------------ -------------------- -- (Complete in Duplicate) — ___ ______________ _____ This Permit Expires 1 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. Thi� PPfication�Is ,made in com liance with CountY Ordinance No. 549. r ,0 r ,,j JOB ADDRESS AND LOCATI N {......1_J_�,__�__f�.�l _ - Owner's Name--------eP li,-- , •f1 l-°1`, lGP1---------------------------,------- - - - ------------------------ Phone------------------------------------ Address --•---------- ; , .. Vale..-- ' -7---- Contractor's Name------ �./(� p�!5�r---------------------------- ------------------------------------ ---------------- Phone----------------------------------- Installation will serve: Residence 5g- Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __/__ Number of bedrooms _cZ._ Number of baths A'__ Lot size42_ae,-e,l�__ __________________________________ Water Supply: Public system ❑ Community system ❑ Private g3-"Depth to Water Table __t _ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam []Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date---------------__- _) No .R2"' New Construction: Yes 2?-'N-o ❑ FHA/VA: Yes ( No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) i Septic Tank: Distance from nearest well ��___Distance from foundation__. -._.____.Mat fial__��e1o.��------------ - No. of compartments_.-A------------ �---- Size tY ----' ---Liquid depth-_ -------------Capacity_h�r4P�.--- Disposal Field: Distance from nearest well-lilll�a__Distance from foundati eV Distance to nearest lot liner._-_...- �4 Number of lines_-_ � .. Length of each line i; Width of trench. -------------- ; Type of filter materialz�� Depth of filter material---� ----_____Total length__,f� _________________________� Seepage Pit: Distance to nearest well----------------------Distance from foundation-----------_------- Distance to nearest lot line-----------------E ❑ Number of pits----------------------Lining material--------------.--------Size: Diameter----------.------------Depth------------------------------ �/, Cesspool: Distance from nearest well--------------___Distance from foundation--------------------Lining material------------._.__________.________r ❑ Size: Diameter--..---------------- -------------------Depth-------------- -----------------------------------.-Liquid Capacity------------r---------------gals Privy: Distance from nearest well _____________________________________Distance from nearest building ---._____..___________---------- ❑ r Distance to nearest lot line------------ --------- - ---------------------- --- -------- - ---------- -------------- ----------------------- Remodeling and/or repairing (describe):-------W __ - - -----.. --------- fir --------------- -------------------------•-------------- ---------------------------------------------------------------------------- ---- ----- --------------------------------- --------------------------------------------------- ------------------------------------------ --------- --------------------------------- t __ 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. I -------_� / G� �,---- ----------------------------------------------�( r Contractor] (Signed) �A BY: ------------------L-l�--- {Title} �� (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). 4 r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED B - - ---------------------------- DATE . .. . .. -6-------------------------- - REVIEWEDBY---------------------- --------------------- ---------------------------------------------------------- DATE-----------------------•------------------------------------ BUILDINGPERMIT ISSUED--------------------------------------------------------------------------- ------------------------- DATE--------------------------- ------ ----------- -------------- a Alterationsand/or recommendations----------- ---------------------------------- - -------------------------- ---------------------------•- ------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------ ---------- -------------------------------------------•--------•------------------------------------------------------------------------------------------------------ ----------------------•------------------------------ --------------- -------------------- ---------------------- -------------------- ------------------------------------------------------------•-•------------- f FINAL INSPECTION SY:.------ ' Date-------- - --------— �'? — ------. ---- --- ------ SAN JOAQUIN LOCAL HEALTH DISTRICT V 1601 E.Hazellon Avo. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.C C.