18324 - Laserfiche WebLink

Home Browse Search

rOR OFFICE USE: t __ --� —� ------------------ -------------- --------------------- - ------------ -------------- -------------- ------------- APPLICATION FOR SANITATION PERMIT Permit No. .•_-ZZ ------------------ �� (Complete in Duplicate) --------------- ------ -------------- - - ---- This Permit Expires 1 Year From Date Issued Date Issued ___ --%7 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. JOB ADDRESS AND LOCATION___,__.__� f f �� { / 1 v 1`^E�C Ct` Owner's Name------ = - _ --- -- -------•-----•- --------------------------- Phone--- . Address------. == `" -----------------•----...-----------•-----•------------------•Contractor's Name Name----------- ---------------- _._ Installation will serve: Residence A artment House Commercial Trailer Co Phone___________________________________. - - -- ---------------? _ p ❑ ❑ Court ❑ Mote! ❑ Other ❑ y� Number of living units: _ -� AA �.____ Number of bedrooms ______.- Number of baths _,�____ Lot size .=�_.,�T-- - Water Supply: Public system ❑ Community system ❑ Private ( Depth to Water Table _ ___ ft. Character of soil to a depth of 3 feet: LSand ❑ Gravel ❑ Sandy `Loam ❑ Clay Loam [jClay E) Adobe E] Hardpan C] Previous Application Made: (If yes,date___._______________) NohN, New Construction: Yes a., No ❑ FNA/VA: Yes ❑ No TYPE_OF�INSTALLATION AND SPECIFICATIONS: . .,..44 t _ 4-p y,..filr=' -ice Mi - (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well------f?_._`Distance from foundation__-__/�_ ._--.Materi I__ - No. of compartme s_-____ ,---------------Size__fz-rY,�� - Liquid depth____---� ---Capacity.... - .-- p __________Distance from foundation. 10 to nearest lot line.__(U Dis osal Field: Distance from nearest well.__-- _.__.__Distance , CZ Number of lines__ __' --------___._-_ of each line---9ti_.__---------------Width of trench--- Type of filter material__557-:Iz°_�%_�---Depth of filter material-.____._ ---------Total length---------- __ N - Yp -- - Seepage.Pit: Distance to nearest well---------------- ----Distance from foundation___.-_____...._.-_.Distance to nearest lot line__----------_-rt� ❑ Number of pits----------------------Lining material--_-------_----------Size: Diameter-----------------------Depth------------------------------_-_ Cesspool: Distance from nearest well-----------------Distance from foundation .___________.Lining materia!-------------------------------------- El ------__._ '❑ Size: Diameter------------------------------ -----Depth ---------------------------------------------------Liquid Capacity------------------------ gals. Dlsfiance.from nearest welL__ _ ___________-_D3stance from nearest building"-----__--_- Distance to nearest lot line_-_______________.- -._ --------------------------- Remodeling and/or repairing (describe):----------------------------------------------------------------------------------------------------------------------- ------------ r -------------------------------------------------- ------------ ----------::----------------------------------------------------•----------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. {Signed--- .._ (Owner and/or Contractor) By:'- -----------------•--------•• - ---------------------------------------------{Title- --------------------------- -- ----- ----- -------------- (Plot plan, showingsize of lot, location of sy stem.in relation to wells' buildings, etc., can be, laced on reverse side). i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-----------------------.-------------- ----------------------- DATE-- ------------------------------------ - REVIEWED BY-=------------------------------- r ' DATE--------- -BUILDING PERMIT ISSUED .f� .b --------------------------------- -1 - -----------•------------ DATE - ----------------------- Alterations and/or recommendations:______--__............. -------•-------•------------------------------------------------------ ------ s - ------------------------- -•--- ---------- ---------------------------- - -- ---- - ------------------------------------------------------- I FfNAL INSPECTION BY: ---- ---- ------ Date- Y �- SAN .1I JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California FS 9 REVISED B-59 3M 3-'63 F.P.CD.