19714 - Laserfiche WebLink

Home Browse Search

/ ��FICE uSE-��, ------- ----- APPLICATION POR---- 'SANITATION PERMIT Permit Na--------- ---------------------tt (Complete in Duplicate) Date Issued ____---- ---_ _- _ This Permit Expires 1.Year From Date Issued' s, � Application is hereby made to the San Joaquin Local Health District for a permit to constru t and install the work herein described. This application is,made in compliance with County Ordinance:N o. 549. N• _ Z7t1—Z� S6� nl . AV&C-f rho r JOB ADDRESS AND LOCATIO12 N- ry - -----•--`-�-- - Q 4Y�-_ ^ Owner's Name_ ---------------------------------- - - ----- ------ ----------------------- Phone-----•-----------------•------_----- Address----••------•----------•--------------------- .:------ � � ; - _` / Contractor's Name______ , ____________________ Phone.i �✓,CF -_- 1-X;� Installation will serve: Residence �A artment House E] Commercial ❑ Trailer Court El Motel E] Other [I Number of living units: __/__ Number of bedrooms -a-- Number of baths --/- Lot:size ------------------- Water Supply: Public system ❑ Community system ❑ Private [Depth to Water,Table 4Q ft. , Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ®• Hardpan ❑ Previous Application Made: (If yes,date-------- I No f New Construction: Yes ❑ No X' FHA/VA: Yes ❑ No ❑ I TYPE OF INSTALLATION AND SPECIFICATIONS:. .= (No septic tank or cesspool permitted if public sewer is available within 200 feet.) is Tank: Distance from nearest well-_________-------Distance from foundation------------------- Material---------------------..._._______.._____.___.- �� No. of compartments---------------------------Size------------------ 4--------Liquid depth------------------------Capacity -- f �- F 41 - Disposal Field: Distance from Barest well �.___.Y__Distan of line ation_�� ---W�t�cofttrenchest lot line1__-.-.�� Numberiof lines______-_ - 9 Ai f . « , Type of filter material__ r_ i6_C. 'Depth of filter m'aterial__ `S._______-...Total length___.____- - -- ----- l r s � r ti7r Distance to nearest Iotrline- Seepage ________________ Pit: Distance to nearest well -_QfJ________-;Distant om f undation____ ______________ J t Number of pits------ -------- --Lining material-__ _ _ .._______-.size: Diameter.-____-- -- - -----Depth--- ---------------- � t Cesspool: Distance from nearest well-----------------Distance from foundation_-_._-_____.____-_Lining material------------------------------------- ❑ Size: Diameter_-_------------ -------- -- ------ ,Depth- ---- -------- ----- -------- -------------------Liquid Capacity----------------------------gals. - - Privy: Distance from nearest well_-----_-----------------------------------------Distance from nearest building--------------------------------------- ❑ Distance to nearest lot line-------- ------------ ------= -- ---------------- --------------------------------------•-------------------------------- Remodeling and/or repairing (describe):_------------------------------ -------- ---•-----------------------------------•----------•-- --------'---•---•------------------------------ I --------------------------------------------T -----------••---------- ------------•-----------------•--------------•----------------------------------- ------------------------- -------------------------------------------- x - ----------- -•------------ ------------------------------ ------------------------ ------------•------•----------------------------- *- r t, f -------------- i 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. I ____________________(Owner and/or Contractor) (Signed) ---------- � , Ttt1e --------------- By:----------------------------------------- -- -------------------------------- ----- ------------------------------( ) (Plot plan, showing size of lot, location of system in relatio wells, buildings, etc., can be placed on reverse side). �F FOR DEPARTMENT USE ONLY - APPLECATION ACCEPTED BY - ----------- --- - ----------------- DATE----- 1 `� -- ------ REVIEWEDBY----------------------------------------- --- ------------------------------------------------------ DATE------------------------------------------------------------ _____ ____ ----------------=-------- DATE------------------------ Alterations and or recommendations:__--_._____ _________ __ .� BUILDING PERMIT I --------------------------------•------- ----------- _ - , ( �. } �� ----------•--------------------------------------------------------------- --------------------------------------------------- - --------------------- -------------------------------- -------------------- ----------------------------------------- ----------------------------------------------------------------------------------------- ------------------------------ FINAL INSPECTION i BY:_ � �I . ate -�� t_........SA JOAQUIN LOCAL HEALTH DISTRICT i 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California i F.P.CC.