21010 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: N APPLICATION FOR SANITATION PERMIT Permit No. . _%�% . k ------ -------------- (Complete in Duplicate) This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct an4 install the work herein described. This application is made in con is ce with County Ordinance No. 549. CJ -of' JOB ADDRESS AND LOCATION- , Z = -- ----/l -------- - ----- ------ 9 Owner's Name-------- �� ----- ! ------._. Phone------------------------------------ >_ 7�1 Address........�•��-------------- Contractor's Name----`--0 '�� Phone.. -----•--•---------------•------------------------------------------------------ -- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: %_-_ Number of bedrooms _,-S.- Number of baths _X-_ Lot size ..--------------------------------- r f Water Supply: Public system El Community system El Private �epth to Water Table ZZP 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---------.--------..) No lam' New Construction; Yes R2--INo ❑ FHA/VA: Yes gi -'No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ' t (No septic tank or cesspool permitted if public sewer is available within 200 feet.) pp Distance from foundation---f2�__...__4-Material_ _ j _��.-._._--.--. Septic Tank: Distance of c om artme is&h--.---.--�r.--ize0�_,t, _-.-X%ll_-.Liquid.,.depth---. --- --- ----Capacityl.-2_e9 Q--_-- Disposal Field: Distance from nearer well.::!(- -----Distance from foundation__/e�7:---------Di3tance to nearest lot line_4_-.-__---- Number of lines---- --...�.--i _ -Length of each line% G__ _` Width of tre fZ j________________________ Type of fitfer material_% - _Depth of filter materiaL%�'_____________Total . length_-----_-.�----__------_-_-_.------_--.-.. (� Seepage Pit: Distance to nearest.well----------------------Distance from-foundation-__--._-_-___----.Distance to nearest lot line-----------------, ❑ N T Number f pits-------- -------------Lining material - ----Size: Diameter Depth ---------- N- Cesspool: Distance from nearest well----------------- from foundation----------:----------Lining material_------------ ----__.__---_----.-.. ❑ Size: Diameter-------------------------------------Depth-----------------------------------------------------Liquid Capacity----------------------------gals. 3 Privy: Distance from nearest weft------------------:-=-- ---_- 'y -- Distance from nearest b0clin- 9------------------------------------------ ❑ Distance to nearest lot line------------------ri---�-m---------------------- - _- Remodeling and/or repairing(describe):-------- -- ----------- ----------------------------------------•-----------•-- ----------- -------------------'---------------------------------------------------I---------------------------------------------------------------------------- -------- ----------------------- G ---------------( - ---- ---------------=----------------------------------------------- + 4 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. i u (Signed)------------------------------ ° -------:( r Contractor) -- B - ` ' r----- �%/t �' ----------------- ----------------------------------------- (Plot --- -------- (Plot plan, showing size of lot, location of system a relation to wells, buildings, etc.,, can.be placed on reverse side). FOR DEPARTMENT USE ONLY I APPLICATION ACCEPTED BY---- '� �'`��f~ DATE----------------------------- --- ------ ------------- ----------------------------- REVIEWEDBY--------------------------------------------- ------- -----------------------------------------------•---- ------------------ DATE-------- ---•------------------------------------------ BUILDING PERMIT ISSUED-------------------------------------------------------------- -----------------------------------_ DATE-------------------------- Alterationsand/or recommendations---------------------------------------------------------------------------------------------•-------------------------------------------------------------- ---------------------------------------------------- --------------- ---------------------------------------------------------------------------------------------------------------------- --------------------------------- ------------------•-------•------------------•---------------------------------------------------------------•-----------------------=---------------- ------------------------------------------------•-------------------- FINAL INSPECTION BY: -- ----- v -.h' ------- Date....... ........------- --------- -------- ------ ------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Nodi,California Manteca,California Tracy,California 4 F.P.0 O. 4