22508 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: CIO -------------- APPLICATION FOR'SANITATION PERMIT Permit No. .................... ------------------------- - -- --- - (Complete in Duplicate --- _-_-- -_ -- --- This Permit Ez ires-1 Year From Date Issued Date Issued 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 5,49. JOB ADDRESS AN OCATION------ �---- -------- ---- --- ------- -------------- 5y, f Owner's. Name. -.- - ---- --- --- --- -- - ---------------- ------ -------t Phoneme --------- 1� ---- .....-. C�,ZP ...------ ........--- ........Address- __. _ _._. __.__._ Contractors Name_.. - - --------- ---- - --------------------- ------------ Phona r,< Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _ __ Number of bedrooms _ZvNumber of baths!Z-.- Lot size ..... .�_... ._t.�L�------------------- Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table*!0- ft - Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe tX Hardpan ❑ Previous Application Made: (If yes,clate-------------------- I No J5, .New Construction: Yes ❑ No-' FHA/VA: Yes ❑ NoV TYPE OF INSTALLATION AND SPECIFICATIONS::-- (No septic tank or cesspool permitted if public sewer is available within 200 fee+.) Septic Tank: — Distance from nearest well-----------------Distance from foundation__________________Material --------------------------------------..__._.._. ❑ No. of compartments------- -------------0---Size-----•-------------- -----------Liquid depth---- ---- ------- --------Capacity---------------- ------ L . . . - -1 / i. Disposal Field: Distance from nearest wefip�li '_Distance from foundation0_. Distance to nearest lot Number of lines._ -e__ f_�_ .___Length of each line--�--i0_Q_.�_l_.._.Width of trench._��4_f-_._`._._-.-..___ Type of filter mat erial.�-6±C k___Depth .of filter material_-_._�__�___-._-..Total length-_....__1_Q._Q----------------- -.- 1 Seepage Pit: Distance to nearest well-_........�--.Distance from foundation---------------------Distance to nearest lot line_.__-----_-_--_._ L� r ❑ 'Number of pits--- ------------------Lining material---------.---------.-- Size: Diameter--.--------------------Depth_..........--------------------- Cesspool: Distance from nearest well .__-_--__-_---Distance from foundation-- lining material-_..-------------------------------- 0 Size: Diameter- -- --------- - - ------ - Depth --------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well---------------------------------------_---------Distance from nearest building-------.-_----.-.__--_--__-_--..-..._--.-. ❑ ' Distance to nearest lot line---- - - --------------------------=-- ---' OF 0 Remodeling and/or repairing jclescribe):--- - -- --- ------- -•------- ------------ ---- -------•--------------- ---•------------------- --------------------- -------------------------------------------------------------------------------------------------- ------ --------------------------- ----------------------------------------------------------------------------- -•---------------�-�-----•---- --- ----•-------------------------------•----------------- ---------------- ---------------------------- ---------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ I hereby certify that I hpared this application and that the w will be done in accordance with San Joaquin County ordinances, State laws, ag"'e�dregulations of San J aquin Lo Health District. (Signed)- - ------ --------- :� �(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). RJ F6 Z DEPARTMENT USE ONLY APPLICATION ACCEPTED BYi__.____.-.._ 1f/ - ------'........... .... . //-. ------------------------------------------------------------- DATE------.. s. = �f----------•--•--------- REVIEWED BY-- - I --------------------- DATES----------------'--._ .--_-._ BUILDING PERMIT ISSUED-------------• --------____-- .-- ---.------------••-----•___-- Alterations and/or recommendations:------- ------ -- ---------------------------------------------------------------------- -----------------------------------------4----------- --------------- ------------- -------------------.------------------------------------................. ---------------------------------------- ----- •--------------•------------------------------ --------------------------- F _.•----------------•--------------..._.--_-_--------------------..--------- ---..._.._-._.----------------------------------------------------------------."_. . ..__..-----_---------•----------------------- ------------.................____-.......I.........----------------------------------------.._._.___-._._.._____--__-_-___-...._._--_.--.-..-.-_.--...-_.-.__-_...___.__._._._._.-___._.___--....__----_..----.-___-_.---._..- FINAL INSPECTION BY: ec ,// �' Date - - --------------------- --------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Haaellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street $tocklon,California Lodi. California Manteca, California Tracyr California E.H.9 2M 1-67 Vanguard Press _ I v,