14243 - Laserfiche WebLink

Home Browse Search

FOR OFFI E U : 1, ---------- f_________________________ APPLICATION FOR SANITATION PERMIT Permit No. _.1.��...:3 I --------------------------------•=------•---------------- (Complete in Duplicate) 5—J`&-t/ .......Date Issued l. - ---------------- ---- ------------------- - is Permit Expires 1 Year From Date !ss _ sued i• Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This plication is made in compliance Oh County Ordinance No. S49. JOB ADDRESS A OC I N _ �.__._._ __ _ �l0 4 2- ------------------ - -- - - - Owner's Nam ' ------------------- Phone.................................... Address - � --•-------••-------------•-----••••-•----•-.....--------••--•-••-----•••----..........-••-•--••-•-----••---• Contractor's Name............. -•-------•---------------•-..---- ----•----..---- Phone..............I...... Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ TraileA4Nto ❑ Motel ❑ Other Number of living units: .___.._. Number of bedrooms ________ Number of baths-••_ e ----- ...�...: :..:.. Water Supply: Public system'.❑ Community system ❑ Private ®�epth to Water Table ft. Character of sail to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay.E] Adobe Hardpan ❑ Previous Application Made: (if yes,date____________________) No ❑ New Construction: Yes Vo ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ' .(No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic-Ta k: Distance from nearest wel/W_______Distance frrom foundation__O2S-_______-MaVal�C. ,e__ _... .. . .. No. of compartments------:__a-----------Size_�7__ ___3�_____.___Liquid depth...�j_/_9,;L-----------Capacity.-1Q 4p. Disposal Field: Distance from•neares well -._._Distance from found '. ation.1 . _...._.Distance to nearest lot _ !!? F Number of lines_____. _. Length of each line....... ..........Width of trench----- _��____p_____--___•-._,7__ Type of filter mater ial------'_-__ � '_Depth of filter material___/__________Total length_______________________ iC�_=___-_----------- .� Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line-----.----------- '_9 ❑ Number of pits----------------------Lining material----------------.------Size: Diameter...........-------..._.Depth-----............................ O Cesspool: Distance from nearest well-________________Distance from foundation-------------------.Lining material....--.______.______..._....._______. m 0 Size: Diameter----------- --------------------------Depth----------------------------------------------------Liquid Capacity------------------------_-gals. j- " . Priv Distance from nearest well_________________ __._Distance from nearest building ❑ Distance to nearest.lot line------------------------------------------------------------------------------------------------....----------------_----------------------- 1 Remodeling and/or repairing (describe)•---- ----- -- -"f----•------•--- . I + ............................................•-----•-----....---•--.----------------••--------------------------------------------------------•-••---••------------------------------••••..._...--------------------•-------.- ----•------- ---------------------•----•-- ---------------...-------------------------------------------------------------- ------------------------------------------------------------------------ �� l I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County , l: ordinances, St aws, and rules andr ulations of the San Joaquin Local Health District. (Signed)._ . d _________ __ _____ ner and/or Contractor By: •--•- •• ---- -------------- � (Plot plan, showing size of lot, location of system in relation to well , uildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY /. APPLICATION ACCEPTED BY---------- -��'-----ice�L� -* ---•----•------------------------------- DATE-------------`�Zy 1 REVIEWED BY-------------•...................... ----- DATE..-•------------------------ ;.. BUILDINGPERMIT ISSUED.... .................-----•-------- ------•------------...._-------------------------------------- DATE.------------------------------------------••---------------- Alterations and/or recommendations-----------------------------------------------------------------------------------------------------------•-----------------..--------------------------------- ----------------------------------------------------------------------------- FINAL INSPECTION BY: --L.------ ------------7----------------------• Date------------ f ` ---------- ---------- SAN JOAQUIN LQCAL HEALTH DISTRICT l 130 South American Streit 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E8 9 AMSEo 8.99 YM 3-61 ATLAS