19075 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: ------ APPLICATION FOR SANITATION PERMIT Permit No. .. 1_._�...�.. ---------------------AV (Complete in Duplicate) Date Issued_---------------- -__. .______..--.-___._._ This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health,District for a permit to const c and install the work herein ascribed. This application is made in compliance with County Ordinance No. 549. �yV r�JU'� — d��f 1 2 3 27 3 0, $ �- � A p r JOB ADDRESS AND�LOCATION. _ ------------ Owner's Name---- -- ---------------------------------------------------------------------- ---------------- Phone------------------------------------ ,' , ---• --- / ---------•- -�Address---------- - -- - -- --...----1 �� ----- ---G -- -- -- -- ---------v--------------------------------------------------------=----- - ------ --- -- ------ - - -- Contractor's Name ------ Phone--------------------•-------•------ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: /""---- Number of bedrooms 3_ Number of baths _Lot size ------Ak ----------- Water Supply: Public system ❑ Community system ❑ Private [Depth to Water Table _v:____ 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 ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: I (No septic tank or cesspool permitted if public sewer is available within 200 feet.) N fW Septic nk: Distance from nearest well__- __--_Distance .from foundation-----/-,0-----Material_____�!1ct ------------------ Distance No, of compartments__-_-_ems____ -'Liquid depth---_..._--_Size_` ��f�X �, f__...._ _ Capacity_... e= __. �J .01 from g c .`p `.__._Len_-._Length of each line___,____-_Distance from.foundation.._ 0 r p Distance to nearest lot line„__________. ir�nt • Disos Field: Numaber of I nesearest well � �_ � Width of trench------- � _________________� Type of filter material___ ___ _,_______Depth of filter material____f___ _-f�__._Total length--- Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line___._-._________ r ❑ Number of Pits----------------------Lining material---------.-------------Size: Diameter-----------------------Depth-----------------------------.-- -� Cesspool: Distance from nearest well________________Distance from foundation--------------------Lining material------------------------------------- M I ' i ----------- Liquid Ca acity= ----- - g gals.th------------- Privy: Distance from nearest well-----------------------------------------------__Distance from nearest building---------------------------------------._. ❑ Distance to nearest lot line------------------------------------------------ --------------------------------------------- ------------------------------------- --------- Remodeling and/or repairing' (describe): --------------------- -----------•--•---------------------------------------------- -------------------------------------------------------- i. I '-----------=--------------------------------------------------•-••---- t � _ = = ---------------------------•----------------------------------- I hereby certify that I have pre ----••--------------------------•----------•----------------- -------------------------------------- -------- pared this application and that the work will be done in accordance with San Joaquin County ordinances, State and rules and regulations of the San Joaquin Local Health District. ,--- (Signed) `.. ---- - ------ -- -- ----- - ---- (Signed) Contractor) BY: - � - ' -.--". a --- _ = - it �. (Plot plan, showing size of lot:.location of system in,relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-.---*, ----------------------------------------------------------- DATE_�----v2----------`-f-r------------------------------- REVIEWEDBY----- ----------------------------- -.-.. DATE----- ----------------------------------•------------------- BUILDINGPERMIT ]ISSUED-- '--I------------------------------ ------------------------------------------------------------ ------ DATE------------------------------------------------------------ Alterationsand/or recommendations:------------------------------------------ ---------------------------------------------------•---------------------------------••-------------------------•- t ---------- ----------------`------------------------------------------------- k ---------- --------------------------•--------------------------------------------------------------------------------------------------------------------------------------------- ------------ i FINAL INSPECTION BY:. Date6�.. r 'G.S� t ................. . SAN JOAQUIN LOCAL HEALTH DISTRICT I i 1601 E.Fla=allon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street I t Stockton,California Lodi,California Manteca,California Tracy,California ES 4 nEVkSED 6-59 3M 3-'63 F.P.00.