20428 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: •; ---- -------------- -------------------------- _------------- ------ __-"-.""-----__._ APPLICATION FOR SANITATION PERMITPermit No.. i (Complete in Duplicate) " -- --- --- ' Date Issued _...............:........ ... This Permit Expires 1 Year From Date Issued . x 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 ith County Ordinance No. 549. JOB ADDRESS AND LMATION - -- ---- -�-""�--- '`�'�-------- --- qJ---- ------ - ----0 _0 _ �d f Owner's Nam ------ .''�----------- --------- --- f ----------- Phone------------------------------------ r .�^ �'� Address.................... ..•---••--•-- --•----- - ----------------------------•-• - • ---------t-'-----•--•-----------•-=---••- •-•---_------------------------------------------------•--------•--•---- ` Contractor's Name-- Installation `- r C ► "� -------------------------------•----------------------- Phone--------_- -----•---------------- Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court C] Motel ❑ Other ❑ Number of living units: ---/__ Number of bedrooms _!` .. Num;4epth f baths - ------- Lot size ----- -1.(1--Gj'�'-�—-------------•------• -- Water Supply: Publics stem Community system ❑ Private to Water Table .---_--- ft.PP Y� Y ❑ Y Y1 E Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam B' Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ l Previous-Application Made: (If yes,dote--------------------) 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.) f Septic Tank: Distance from nearest well----- __7__Distance from foundation---------------------Material------------------------.---------- ❑ No. of compartments------------------- Size ------------------------------Liquid depth----------- - ------- - --Capacity----------------- Disporield: Distance from nearest well.-- 4'"_.._._Distance from foundation-----4_d-........Distance to nearest lot line-------------- Number --------Number of lines--------- -- ------ ----Length of each line-------9z`.0...............Width of trench...-_-------'.--_._-_-..---___-__ Type of filter material--------$.A r------Depth of filter material......t--...........Total length----/4-&---------------------------- Seepage Pit: Distance to nearest well-----------------------Distance from foundation--------------------Distance to nearest lot line----------------- (A ❑ Number of pits-------------------- Lining material-_---_._.-_.--.---..Size: Diameter-----------------------Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation_-_-__- ---.-_.Lining material-_..-_----_-__._-_--__---___-._._ ❑ Size: Diameter------------------------------------Depth-_r__-``-------------------------------------Liquid Capacity---------------------------gals. Privy: Distance from nearest well------- ------------------------Distance from nearest building.__-.---__.---.-----_---__---_---_-.__._. ❑ Distance to nearest lot line---------------------------------- -----------------------------------•------------------------------- ---------r-------- Remodeling and/or repairing (describe): ----------------------------•------------------------------------------------------------------------------ i iz --------------------------------------•---------------------- :4'' -----•---`-----------------.- ----- ------------------------------------------------------------ ----------------------------------------------=------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and fhat_the work will be done in accordance with San Joaquin County ordinances, Stat a s, and rules and gulations of the San J"quin Local Health District. 1-6 (Signed)----- ----- - -- ----------------------------- ...and/or Contractor) f By .. ------ ----------------------- (Title)=" -= - (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on-reverse side). t FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- --------- ---------------------•_---------- DATE----t, 1' ! REVIEWED BY ---------------------------------------------- -- - DATE I BUILDING PERMIT ISSUED-------------------------------------------------------- „. . ,- -- -- --------------------------------------'------------------------- RATE------------------------------------------------------------- Alterations ---- ---------------Alterations and/or recommendations------------------- t -------------I------------------------------------------------------------ ------------------------- ----------------------------------------------------------------------------------------------------------- ' -------------------------------- ------------------------ ---- ----- ---------------------•----------------------------------------------------------------------------------•--------------------------------------- --------------------------•--------------------------•------------------------------------- --- - ---------------------------------'- ---------- ' } ----- ------ J� i F FINAL INSPECTION BY:.__._... --------------------- Date. SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy, California F.P.C C. i 1!' ��