19854 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: ---------- --------- - y ds'______.----_!..A_... APPLICATION FOR SANITATION PERMIT Permit No. ..�� --------------- ---N-------- - - (Complete in Duplicate) �f - This Permit Expires 1 Year From Date Issued Date Issued ._�f.`_: .... Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION..,-f_,_,;2--3.2 Owner's Name_06E----- - - - Phone.................................... Address,,,..1,�. .... Contractor's Name--------- --- o_...1--------------------------------------------- -- ---------------- Phone................................... Installation will serve: Residence [!I--Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---t--- Number of bedrooms __3_ Number of baths 1------ Lot size ____ '__ _ _ v_______________________________ Wafter Supply: Public system ommunity system ❑ Private ❑ Depth to Water Table ---i(- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe erIH-ardpan ❑ Previous Application Made: (If yes,date--------------------) No IT— New Construction: Yes FZ?"No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) �f Septic T k: Distance from nearest well--- ----_-.--Distance from found _1 ation_ 1_-__-_-__-_.Material_-..j�� -------------------- No. of compartments_._. _ __________Size... _ 4_y 9_---_:___Liquid depth_l-_-.__-.-..___-_.._Capacity..:A?.o9 At( Disposal Field: Distance from nearest well--- ----------Distance from foundation__d_0_____---------Distance to nearest lot line---4:�....... 15'" Number of lines.....-------------------------Length of each line---.� : -------------------Width of trench___-Z_'y,_y_____-__----____ Type of filter material _�_�_0__c.'t:_______Depth of filter material--- ------------Total length_-.--------------------------------- ---- _:t?_--_______________________ .� CJ Seepage Pit: Distance to nearest well _____---_-Distance from foundation__!.;!_`__-__-.-.Distance to nearest lot line__-.?.._____---_ Number of pits._.__..._--------Lining material. A___-Size: Diameter-__-33_-----------Depth_____ -- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material--------------------._--.__.___----. _ ❑ Size: Diameter-------------------- ----------- ----Depth-------- ----------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well------------------------------------------------- from nearest building------------------------------._-_____-_. ❑ Distance to nearest lot line-------------------------------------------- ----------------------------•----------------------------------------------------- Remodelingand/or repairing (describe):--------------------------=-------- ---------------------------------------------------------•------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ I hereby certify that I have prepareo this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules an r gulatio of the San Joaquin Local Health District. (Signed) __.__.__________________________________-_____.__._______.Owner and/or Contractor By:-----------------------------------------------------------------------------------------------------------------------------------(Title)---------- -------------------------------------- ----- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY__ C-______--.-____--._-._ �/�1 61' - DATE ----- •-------------- ---------------- REVIEWEDBY-------------------------------------------------------------------------------------------------------------------------- DATE BUILDING PERMIT ISSUED------------- D TE---------------- Alterations and/or recommendationsf7 ��. --- s --fi -- R----c L------------ •------•----•---------------------------------- ----_------•-----•-------- --------------------•-------------------------------------•---------------------------------------------------------------- -----------•------ ---•-------------------------------•----------•--- --------- ------------------------------------------------ ------ ---------------- -------------------------------------------------- --------------•----.------------ --------- ---------------------------- ---------•-------------- •---------• -----•-----------•-•----•---- --------------•--------------------------------------------- -------------------------- FINAL INSPECTION BY:-.___..�------------- --------------- _---- Date r t 2 -_ 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 F.P.CC.