22290 - Laserfiche WebLink

Home Browse Search

FuK-OFFICE USE: ` w ------------------Ik----------:------------------- APPLICATION FOR SANITATION PERMIT Permit N9. ------------ ------- - Date Issued (Complete in Duplicate) p --------------------- _ _ - This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install t31e work herein descried. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION 3- --------��"��----- f' ---------------------------- - �-1-- -------------------------------------------- Owner's Name---------- ------ ---- .� ------- ------------- Phone------------------------------------ Address_.... ------------------------ , ----- -- •----d-------- ------•--- Address ��►0, -- r - -+ -- ----- -- ----- �y Contractors Name-------- i- -•-t `± �E:��------ --- ------7Pi one---- - ------------------------------------------------ 1 Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ ` -0 Number of living units: __!-__ Number of bedrooms Num_b'er of baths _�___ Lot size i�__s.. �/_-______-_______.__-.__ Water Supply: Public system 'Community system ❑ Private q] Depth to Water Table& fty Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑% Adobe &-11ardpan Previous Application Made: Ilf yes,date-------------- } No gq--1Vew Construction: Yes ❑ No W;---FHA/VA: Yes 9�— Vo ❑ ••j,, TYPE OF INSTALLATION AND SPECIFICATIONS: .,._ (No septic tank or cesspool permitted if public sewer is available within 200 feet.) t w, Septic.Tark'v Distance from nearest well-----------------Distance from foundation-------------------Material-__--.._-._-....______-_.-____--_--..._________- t IF �j No. of compartments..........................Size______________ �--••--------�Liquid iquid depth--------- 3 ---- -Capacity---------------------- Disposal � Fief: Distance from nearest well________________Distance from foundation----_.--------------Distance to nearest lot line-__________..-... Number oflines-----------------------------------Length of each line---_-------------------------.Width of trench-------------,--.------------------ 1 Type of filter material------------------_______Depth of filter material____.____.________Total length___________--_--__-____-__-----__---__-.__ +� s Seepage Pit: Distance to nearest well-___tr�______Distanc-e on2V_-_------.Distance to nearest lot iine��~__.-_ Number of its,-± __ Linin material_ Si Diameter-- .S ia rieter__ r/ �__________________ p = 9 _ Depth 4 Cesspool: Distance from 17arest well_____-_____._._.Distance from foundation Lining --------- j material________________________________ ____ ❑ Size: Diameter- ---.De th_.____-... --------------- -----------Liquid Capacity_ -----gals. -' `# Privy: Distance from nearest well_______________________________________.:.-_._.Distance 1i from nearest building__________-.._-_-_________--__-.-.--_- ❑ Distance to nearestlifot line-- - ---- - ----- -- -'- ={ ' Remodelin sand/or repairing (describe:----------------- /.__�_.�.._- _ -_,- ' - I .. �s -------------------------------------------------------------------------------------- --- ---- ------------- ---------------------------------------------------------- ----------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County i ordinances, State laws, and rules and regulations of theSanJoaquin Local Health District. (Signed) , � J -- ----------------- ----- F or Contractor----------- Title -------------------- I(Plot plan, showing size of lot, location of syste i elation to wells, buildings, etc., can be'placed: on reverse side). t FOR DEPARTMENT USE ONLY ' APPLICATION ACCEPTED BY----__ .-_ ----------------------- DATE--- ------- REVIEWEDBY.-----` ---------------- DATE----------------- ----------------------------------------- BUILDINGPERMIT. ISSUED-------`----------- ------------------------ -------------------------------------------- ------------- DATE----------- ------------------------------------------------- Alterationsand/ot.recommendations:------------------------------------- ----- - -------------------------------------------------------------------------------------------------------------- J ---------------------------- ----------------------------------------------------- --- ------------------------------------------------------------------------------------------------------•------------------- ---------------------------------------------------------------- ---------- --------------------------------------------------------------------------------------- ----------------------------------------------. --- -------------------------------- -------------- -------------------------------------------------- - -------- - ---------------------------------=----------- FINAL INSPECTIONBY: ----- Date-- � Y SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave, 30o West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO. jf$