19480 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE:. �`1 I ., ` j ` APPLICATION FOR SANITATION PERMIT Permit No. --- ----------------------------- ---- (Complete to 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 construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. rA / � e JOB ADDRESS AND LO ATIOI�_-_� / _�_rTI_R_P RT___l V/� __ _ -___�a�7.c___ .___. RENCti-----�P--- PD. Owner's Name L.—OZ�-N_.0--------------------------------- ---------------------------------------.... Phone.................................... Address------------- 41...........15.--------5 .......JOA-00-1-.04........... -X.M.- .. --- ------- - - .......................................... Contractor's Name__i�'�_©5.F-RT_H___..__ . __'._..- - Phone................................... Installation will serve: Residence J!r- Apartment House ❑ Commercial ❑ Trailer Curt Lj Motel ❑ Other ❑ A Number of living units: _(____ Number of bedrooms .3- Number of baths AZ. Lot size _ y_'�1Q _____ _..___. Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam f!r Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date-------------.------) No gr New Construction: Yes ❑ No Z-__FHA/VA: Yes ❑ No r' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ReDwoot> Septic Tank: Distance from nearest well___ _Distance from foundation------/L..___ .Material __A 140_ 9— No. of compartments_._-. — - ---Size--y.A0"__ __X__5____LI uid de th ��-'2 —- - ----Capacity-1zO-O Disposal ---- Field: Distance from nearest well Q_._Distance from foundation___l0._____-..Distance to nearest lot line____�y-----tr Number of lines-------- :_._ ___� ____.__.._ Length of each line__ =___� -..Width of trench___.__'____ p '--' LTJ Type of filter material--- _Q_C K__Depth of filter material---._.t9._-------Total length_________________:_____ Seepage Pit: Distance to nearest well---------------------- from foundation___________________.Distance to nearest lot line---- _ _C_'._ ❑ Number of pits----------------------Lining material--------:__.--------- Size: Diameter------___----------Depth--------------------------------- 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 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) ----- ---------(Si ned) � �__� - - -(Owner and/or Contractor) By:-------------------------------------------------------------------------------------------------------------------------------------(Title)--------------------- ------------------------ -- ------------- (Plot plan, showing size of fot; location of system in relation to wells, buildings, etc., can be placed on reverse side). - ._ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------�y--4-R-itO--------------------------------------------------------------- ----- DATE---------- +''� - ----------- REVIEWEDBY----------------------------------------- --------------------------------__---------------------------------------------- DATE---------------------------------------------------------- BUILDINGPERMIT ISSUED------------------------------------------•-------------------•--------------------------------------- DATE----------•-------------------------------------------------- Alterations and/or recommendations:--------- =f1 l .0 t_`_ ___. ' __...fafl!�.................................. ---------------------------------------------------- --------------------------------------------------------------------------------_-------------------------- --------•-------------------------------•---- -------------------------------------•------------- -------------------------•----------------•--------------------------------------------------------------------------------------------------------- f1------ t --------- ------ -- --------- -.__ ------ ------------ ------------- --------------------------------------------------- 7 Date_.-._--- ZFINAL INSPECTION BY.---e1 SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO.