20971 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: -------------------------------------- ---------------- --------------------- APPLICATION FOR SANITATION PERMIT Permit No. .'7 `~- - -- - ------ (Complete in Du licate P ) / ___________________ ______________._.-_______ This Permit Expires 1 Year From Date Issued Date Issued ....s� 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. Wt4TE A JOB ADDRESS AND LOCATION._ Vs71-_V-----1U____s?tA__.I PP_1'-_t tA--C? __�A_!!/af'-P._.�_�,e esS like Owner's Name--f/Y/ ------ Phone------------------------ - -,--/-�_14.7_'�i_Jc-lcEs--•------------------------------ --- ---------------- ----------- Address------7.Z------------- l2/__Q..0 ------------- -1V-7_ C Contractor's Name---- (� �� ------ Phone----------------------------------- Installation will serve: Residence IX ApartmelHouse ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ F �___- Number of bedrooms__- Number of baths --__--- Lot size -_._-1��4Q -_..___ '_______.____ Number of living units: __ p................. Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table 1 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 New Construction: Yes ff"No ❑ FHA/VA: Yes [Q'---No ❑ 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---ji;�-----Distance from foundatio� �U.._____..Mater ial-_<M NCK E.T_rte_...-__-_. ly No. of compartments--_ 2------------- I -__- ---- -.Size._ ../_x.�� i uid depth__._____________Capacity-_- Disposa eld: Distance from nearest well___.t`? ___-Distance from foundation--------------------Distance to nearest lot line_--- -_---- Number of lines-------------Z-----------------Length of each lin e------- ---Q-_.-__� ----Width of trench_---.-M;;�.-__----_-__.______._... y Type of filter material-----)20_�.--Depth of filter material------ f----------Total length-__ A5-0________________________ 3- Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line-----------_----_ ❑ Number of pits--- Lining material----------------------- Diameter---------.-------------Depth--------------------------------- Cesspool: ______-_.-_.............._..-_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----------------------------- 17-1 Distance to nearest lot line----------------------------------------------------------------------------------•------------------------------------------ 0 Remodeling and/or repairing (describe):----- --------------- -------------------------•--•------------------------------------------------------ ------------------------------------------- --------------•-------------------------------------------------------------------------------------------------------------------------------------------------------------=------------------------------------------------ ---------------------- ---------------------------------------------------------------------------------•---------------------------------------------- - -------- - ------ ------- -------- - I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County V1 ordinances, Stat laws, and rules and regulations of the San Joaquin Local Health District. (Signed) S Z ... y= ------------------------------------ ----------------------- ----------------------(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------- --------------------------- ---------------------------------------- DATE...... ----------- ------------ REVIEWEDBY---------------------------------------------------- -------------------------------------------------------------------- DATE---------------------------------------- ------------------ BUILDINGPERMIT ISSUED------------- -------------------------------------------------------------------- -------------- DATE-------------------------------------------------•----------- Alterations and/or recommendations:--.-___.--TtQ4T-----t/..N_�-------JV0_:T77:.__•... .-__-_-Alr ------------------ ------------- -------------------- ------------------------------------ 1. -H---------------------------------------------------------------------- -------------------------------------------------------- ------ ------------------------------- ---- ----------------------------------------------------------------------------------------------------------------- FINAL INSPECTLQN - Date------------- ~4�------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,Salifornia Manteca,California Tracy,California F.P:C C. 7