68-206 - Laserfiche WebLink

Home Browse Search

OR OFFICE USE: ` - --------� - ---_.-____ APPLICATION FOR SANITATION PERMIT Permit No. .....__............._. ------------------ i (Complete-in Duplicate) .��_-___--.-_._. This Permit Expires 1 Year From Date Issued Date Issued __ 3..:............ - -------------- ` Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein descrbed. This application is made in compliance with County Ordinance No.. 5549. JOB ADDRESS AND LOCATION -R_77A ---------- -41VJ7E_ ,,. .-S------------ 1...-- •--------- A w ^ =© Owner's Name------------- --- -- •-10-•-------•--•/*A-A �D-�N-/'>r.D.0---- ----------------- -------------- --- Phoneie4 6.314 Address..................................... --- ---- Contractor's Name---------------- --- - ----- i• -- .---- --------- ............ Phone_4Nk7 P ---- Installation will serve: Residence X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: I_____ Number of bedrooms 4--_ Number of baths-./__-_ Lot size A020_X Zp ..._.. - Water Supply: Public system 5j� Community system ❑ Private ❑ Depth to Water Table 7f Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeA Hardpan ❑ Previous Application Made: (If yes,date--------_---------- ) No Ot New Construction: Yes ❑ No)W FHA/VA: Yes ❑ No K 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 ------------------------------------.-_-.-_--__. EI&M,A/C No. of compartments----------------------_--Size----•-------------_ -----------Liquid depth-.--.-.-- ------ ------- Capacity----------••---------- e Disposal Field: Distance from near st `Qell.� .N0-Distance from foundation--- -_---.Distance to nearest lot li a 11 -�__.__---__. Number of lines-_�1_J. ____-- -_.-.-_Length of each line_ 7Z- .-_-_. Width of trench JI . .__ /f------ Type of filter material._ .__.. .. _. _--__Depth of filtermaterial-_-_1_$_----------Total length------7.5r__.____________ Seepage Distance to nearest well.- --_Distance f om f undation---_-fQ_ ..Distant to nearest lot line......... .... Number of its.._.__. Linin material__- '. Size: 9w+ ser.6_f,,�46.g__-Depth----j__1/..................... 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 - ------m---------------------- --- -------•- a h Remodeling and/or repairing (describe)=----- --- • --------------------------------------- - ---------------------------------- ----------------------------•-------------------------------------------------------------------------------------------------------------------------------- ------- I hereby certify that I have prepared.A' application and that thew k will be done in accordance with San Joaquin County ordinances, State law r e nd reg t' ns of the n Joaquin Lo Health District. (Signed) -----------------•------------- ---------.-------.----(Owner and/or Contractor) (Plot plan, showing size of lot, of system in relation to wells, buildings, etc., can be plat d on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - ---------------------------------- --------------------------------------- DATE---------"!-_O 4�•------ REVIEWEDBY-------------------------- -------- --------- --------------------- ------------------------------------•------------------ DATE - BUILDING PERMIT ISSUED----------- ---------- ------- ---------------------------------------------------------- DATE-------------- Alterations and or recom en ations:._._-..___--_ _----------- ---_ ___.. .................--------------------------- -----• --------------------------- ------------ -------___............ ------•-----_---- ----------------- ------------------------------ ------ _ -- --- -------- -----• -------------- >11 FINAL INSPECTION BY:.. Date.,, 3-'- '"�r -------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California E.H.9 2M 1-67 Vanguard Press