68-209 - Laserfiche WebLink

Home Browse Search

rICE USE: --------------------------------------- --__._. '//-�a_--- - �v� APPLICATION FOR SANITATION PERMIT Permit No. --- ------- ----------- s} (Complete-in Duplicate) ---- --- --------------- ---- This Permit Expires 1 Year From Date Issued Date Issued _3------ Application :___-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. / � 1 JOB ADDRESS AND LOCATION .__ o = ---------- / rC -3 ----- A-- ----- Owner's Name 1�-- --- -- .Y }1 � C.f - ------------------------ ----------------------- Phone----------------------_-- Address---------- /7? .: rt ---------------_ ---- -------- ------ - ----------------------------------------------- ---- ---- - -- ` Contractor's Name ` --------------------- ---------._- �� '� l- �-' '� ------- - Phone----- --=---=------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __j_-._ Number of bedrooms__ Number of baths ,f__ Lot size -/-__<tC'__ -- ---- ---------------------- Water Supply: Public system Community systemPrivate ❑ Depth to Water Table ______ _ ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeHardpan ❑ Previous Application Made: (If yes,date__ ------_-------- I No ❑ New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Distance from nearest well_-.-___.____.__Distance from foundation__.---------------..Material ------------ ................___. No. of compartments------------------ -----Size-------------------- -------Liquid depth--------- ------- ------- Capacity----------------------- w� F 7 sal Distance from near�jst well--l _Distance from foundati n__� - __...Distance to nearest lot line__-��-- 'Number of lines-___Z:': Length of each line__ i� - :------ ---- ---- �-�-------- --------Width of trench.��---------- - r' i� — f Type of filter material ----Depth of filter material_/ " /' - Total length - 0 O Seepage Pit: Distance to nearest well ------------------.---Distance from foundation--------------------Distance to nearest lot line-----.________.-_ ❑ Number of pits--. -----------._--Lining material------------------- Size: Diameter----------------------Depth---------- ----------------- Cesspool: Distance from nearest v;ell .______. -------Distance from foundation..- ------------- ..Lining material__________-_____._____________-_ ❑ Size: Diameter- -- %?r -------Depth_----- ------- - --- Liquid Capacity_ gals. --------- - Privy: Distance from nearest well ---<-------------- -------------.------ ..Distance from nearest building--------------------------------------- El Distance to nearest lot line_.._____ __D_ ---------------------------------------------------------------------- ________.-_ Remodeling and/or"repairing (describe:__.__._ - ----- - -- -- - - - ---- ----- ------ - ------A hereby certify that ( have -------------------- - --- - -------- Y y prepare t Is application and that the-work will be done in accordance with San Joaquin County ordinances, S ws, and rul s and re ulatio f the San J quin Local Health District. t L 1 (Signed) (� = I -- -_I------ -- Contract BY:-------------------- (Tale) ---------------- ------- Or p (Plot plan, showing size of lot, location of s stem in relation wells, Y buildi s, etc., can be laced on reverse side). F DE ARTMENT USE ONLY APPLICATION ACCEPTED BY_ ___._._ 1` /i — REVIEWED BYE f --- -------------------------------- DATE- F --------------------------------------- --- - �- - - - -- - ----- DATE BUILDING PERMIT ISSUED-------- -- - ------------------------ Alterations and/or recommendations:__- ----------------- DATE ----------------- ----------------- ------------------ -- --------------- --- - FINAL INSPECTION BY:_ ___-__ Date___.-.__-_ 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 E.H.9 2M 1.67 Vanguard Press Tracy,California