68-343 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: =' ----------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. C�`__3 --- ------ ------------ - - --- ---- -- (Complete in Duplicate) This Permit Ex fres 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. 549. JOB ADDRESS AND LOCATION--- -------.� .. ._, �_._ l-v"� ----------------Y--.�- Owner's Name-------G',O?._.... s - ---. Phone--•-•---••-•-------------------- Address..---- .7 •.:.. ------- ------ ----------------------------------------------------------------------------------------- a f"",------------------------*-------------------- ------ ---------------------------- Address...... .... ------------------- Contractor's ---------------------------------- ---- Contractor's Name__.-- —G. � �----------•------- -- Phone.. Installation will serve: Residence .Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___ Number of bedrooms ._ Number of baths./... Lot size ________________________________ Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table _7P ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Olay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,dote-- -------------- ) No @?O�New Construction: Yes Q No FHA/VA: Yes to ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ,. Septic Tank: Distance from nearest well _.Distance from fours do _.._ . .___._Ma0r l -,,00,01 P '! - No. of compartments...___ .__::_......$ize. -__ I1r quid depth_��__.. ........CapacityY 0.___ \ Disposal Field: Distance from nearest well---e6� .._Distance from foundation__ _. _~_..::Dia#ante to nearest lot line____ Number of lines------_--- __,�,_.___ ength of each line_.49W._...�___--.Width of trench_�-_.-___�__________________ Type of filter materiaL/.tA,0 ._._ epth of filter material__,/P-_...______-Total length__/2-�� ---------------- i Seepage Pit-• Distance to nearest well_./�a�._Distancem fo ndation__�t�_____._.D•st to nearest lot lin,--F--------- r^� Number of pits._. _ _......_.__Lining material/ f . Size: Diameter__ ' __.._.__ Dept62-.—f --------- Cesspool: Distance from nearest well ------------- Distance from foundation_ - ..Lining material .. ❑ material_ ________________-____._.________ Size: Diameter- -- --------- -- - ----------------De th_.._._.---------.--__----- -------:------ -------._Liquid Capacity----------------------------gals. Privy: Distance from nearest well--------------------------------------...........Distance 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)-------------- -------- ---- - --- ------------ -------------------------- -------------- r ontractor) By:------------------------------- ---------- - ---------------(Title)--- (Plot plan, showing size of lot, location system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - ----------------------------- --•----------- DATE.- ---------------- REVIEWEDBY--------------------------- --- -' '---- - ---- -------------------- ---------------------------------------------- -----. DATE---------__--------------------------------- ------------- BUILDING PERMIT. ISSUED.------- ------------------------- -- --------------- ------------- ------------------ --- ---------- DATE------------------------------ - ---------------------------- Alterations and/oi• recommendations:-------------------------------------------- --- -•---•------ ------------------------------•-------- ----------------- - ---------- ----------•------- ------- ------------------------------------------------------------------------•------------- ----------------- --------------------- ------------- -- ---------- ------------------------------------------------------------ ----------------•-------------------------- - ---- r� � 'f� FINAL INSPECTION BY:: � ------- rG ---------------- ............. SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazeltan Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street it Stockton,California Lodi,California Manteca,California Tracy,California - E.H.9 2M 1.67 Vanguord Press - r