22034 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: --------------------- ------- '77, -----------------_ APPLICATION FOR SANITATION PERMIT Permit No. .. ..... --- - - - - - - - - - (Complete in Duplicate) ------------------- --------------------------- This Permit Expires 1 Year From Date Issued Date Issued Applicatio is hereby made to the San Joaquin Local Health District for a permit to construct and insta4 the work herein des ibed. This applica n is made in compliance,witCount Ordinance, No. 549. JOB ADDRESS jZ AN O AT ON_� - ----- --- ...----- Owner's Name-------- :_._.-_-.---+------___ ----- _ -- Phone--�� _--_S ------- Address------------------------- Address------------------------- -��..c........---- .' � Contractor's Name------ ---------------------------- Phone/ ' ...... Installation will serve: Residence ❑ Apartment House ❑ Commercial [Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms ------.- of baths -------- Lot size ---- ®--- "�" - ------------------- Water Supply: Public system ❑ Community system ❑ Private [!r-""Depth to Water Table .72�rft. 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 New Construction: Yes 211No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if pubic sewer is available within 200 feet.) y j L Septic T nk: Distance from nearest well-6 -__Distance from foundation____.�__�_�________-Material-pi�IL _.__________________________________- No. of compartments_____ Size r?�_ ___ __Liquid de th_-._ �____-_____Ca acit �_�� _ Disposal field: Distance from nearest well._75�.____Distance from foundation----o?..�-`_'_______-Distance to nearest lot line.:�5_______.. Ee Number of lines________ _______ ____-_._Length of each line_7_S_�___71S__--____.Width of trench------- -____--__-___.___ Type of filter material__-:_ !�k-Depth of filter,material-_-_1ko_..______Total length----------1-6-41------------------- _N _f y- , Seepag rr: Distance to nearest well./4 ___.---.-Distance from foundation--Z4!52.-`---._ Distance to nearest lot line-z5-____'-"7/ Number of pits------- -----------Lining material_ c1_t'�____Size: Diameter----- ---------Depth------- 5_________________ 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-------------------------- -------- ----------------------------------- ---•------------ ------------ ---------------------------------- Remodeling and/or repairing (describe):---- --- -----1------- °------ - —_---- �_._-______ ---------------------- -------------•-----------------------------------------------•---------------------------------------------------------------•------------------------------------------------------------•--------------------------------- e ----------------------------------------------•-------------------------------------------------------------------•---------------------•---------------------------------------------------------------------------- ;J1 -------------------------------- ----------------------------•-------------------------------------------------------------------------------------------•----- --------------------•------------------------------------ .... eo I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County I ordinances, Sta a laws, and rules and re lations of the San Jo quin Local Health District. AG (Signed)-------------------- -- ------------- ----------- (O ner and/or Contractor) By:----------------------------- -+_ � /. _d�-------------------------------(Title ) - - -------- (Plot plan, showing size of lot, location of system in relativfi to wells, buildings, etc., can be p red on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY. �� 6 � l� -�= --- -------------------------- DATE--------------�------ - ------�------------------- - ---- - - ----- REVIEWEDBY-------------------------------------------------------------------------- . -- ------------------------------ DATE----------------------------------------------------------- BUILDINGPERMIT ISSUED------------------ ------------- -----------------------------•--------------------------------------- DATE------------------------------------------------------------ Alterations and/or recommendat' :_.____ _ ------------------------------------------- ------------------------------------------------- --------------------------------------------- -------------------------------------------- ------ --------------------------------------------------------------------------------I-------- -------------------------------------------------------------------------- ---------------------------------------------- --------------------------------------- ------------------------------------------------- FINAL INSPECTION BY:.L- —/-w `"��`-r-c'- Date------ f 4-- r ---------- -------------- i SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street- 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO.