19469 - Laserfiche WebLink

Home Browse Search

f FOR OFFICE USE: ' ------------- APPLICATION FOR SANITATION PERMIT Permit No. E - (Complete in Duplicate) _________ ___ This Permit Expires 1 Year From Date Issued Date Issued I 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 O finance No. 549. JOB ADDRESS AND LOCATION - ------ ------ �X M------------------------------------ �-�--�----------------------------------------------------------- Owner's - ---- ---------- ------------ - -------- ------ Owner's Name-------- f------- ��f'� <. ----- ----------------------- ---------- Phone'--•-••------------------------------ Address----- ------------------ �,,.o� /------------ _ x------/10-----`-�'-0------- � Contractors Name--------------' l-5-/------------=�,'��------- -------------------------------------------- Phone----_____---------_______---------- Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __/_____ Number of bedrooms ___11--Number of baths ---!_-_ Lot size e-_________________-- Water Supply: Publics stem Community system Private ,, De th to Water Table _ ft. PP Y� Y ❑ Y Y ❑ L�1'" p -- � Character of soil to a depth of 3 feet: Sand ❑ Gravel❑ . Sandy Loam ®Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ I Previous Application Made: (If yes,date--------------------) No ❑-"New Construction: Yes ❑ No [;j,--FHA/VA: Yes ❑ No ©/ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is availablw v4thin 200,feet.) r / Septic Tank: Distance from nearest well-1-00____Distance�fror�f�foundation..... u�� _____Material ____ ❑ No. of compartments_-._____----------------Siz __ k� j q depth___.�1_`9--------Capacity__ffh I Disposal Field: Distance from nearest well 0_._Distance from foundation f �_�-Distance to nearest lot li `�� 1__ Number of lines---------___ '"./t._ _._Length of each line___ ___ U-__-Width of trench �� ---------------- Type - ___ T e of filter material--- �� _Depth of filter material �.- Total length -- f Yp .. / g t Seepage Pit: Distance to nearest well----------------- ----Distance from foundation__________________.Distance to nearest lot line-------._______-_ 0 l ❑ Number of pits----------------------Lining material-------------------.---Size: Diameter-------------- ---------Depth-----------__--_______---__-___ Cesspool: Distance from nearest well-----------------Distance from foundation------_-----------__Lining material______-_____- __-_-_____--__. Size: Diameter_:---------_......_-------------------Depth-------------------I-------I- _ ___________Liquid Capacity gals. _________Distance from nearest building Ptirivy:_ ---------------Distance from nearest well, -_ ____._- g------------------------------------------ r ❑ Distance to nearest lot line---------- - ^ ' -------------------- ------------------- --------------------------------------- -----------•---------------- ---------------------------- Remodeling and/or repairing describe :_____ ` -- l _________________ - ------•----------------- 1 - ---- ------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and thatithe work will be done in accordance with San Joaquin County ordinances, State laws, and rul send regulations%tf thelSan Joa in Local Health District. f - (Signed)--`�'----------------------------- - -----1__------- ------- �� -- -----;----- - ------ -- --- - -----------, - -7-.(O ner and/or Contractor) By:-------------------_____ � ;.��-`''----------------------------------------------(Title)------C__: __;,;m -------- ------- --------- (Plot plan, showing size of lot, Iocat ion of s stem in relation to wells', buildings, etc., can be placed on reverse side). , FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY---------------------------------------------------------- - ------------ ------- ------ DATE------------------------------------------------------------ f REVIEWED BY------------------------------------- ------- ` , DATE ---- - --- ----- BUILDING PERMIT ISSUED----------------------- --------- -------------------_------- ---- - ------------- DATE---------------------- - ------ oo I Alterations and/or recommendations:_---------------------- -- -- -------- = ` yZ --- ------------------------------------- -- ----- - ----------------------------------------- 14, "_.--•- . *= !- - -------- -------------- ------ --- --- -------- ------- a N { --------------------------------------------- ---------------------- --- -- -------- ------ --- ------------- -------------------------------------------•----------------- ------------------------------- FINAL INSPECTION BY: --- ----------------------------- Date----------11-f�--` - ------- 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 �