20700 - Laserfiche WebLink

Home Browse Search

FOR SCE UME:. - ----------- -- ------ APPLICATION FOR SANITATION PERMIT Permit No. oZ ��' --------------------------------------------------------- ---------------------------------------------------- --- (Complete in Duplicate) 8—6 __=_'__ --------------_____________._-_.______-___.------- 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 and install the work herein described. This application is made in compliance with ounty Ordinance No. 549. JOB ADDRESS AND LOCATIO, __ ► _., ,,___ CIt, . .1 'Owners Name r� one4 Address------------------ .. .........Phone ContractorsName--------------------------------------------------- rt _ ------------- --------------------•- •------ ------•--- ------------------------------------ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms �7-__ Number of baths -------- Lot size _____ le__ _C-- ----________________ Water Supply: Public system ❑ Community system ❑ Private 2--Depth to Water Table -7- --- 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 E] FHA/VA: Yes ❑ NoRa ' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public ,sewer is available within 200 feet.) Septic T nk: Distance from nearest well___._ -----Distance from fouq�lation----f i -----------Material =#�'CL (�f ►4xi,> No. of compartments----- I __ de th_-!4-' _ s! Capacity-----` Disposa�.eld: Distance from nearest well ; _Distance from foundation '� ___. _.Distance to nearest lot line__�e i ,,,f----------- [ Number of lines-------:,zJ1 _ _ Length of each line__1ee1 ;_- d+h of trench __., �_________ ____ ' Type of filter material./_.z. .__ ';Depth of filter material_ ��.------ Total length__.------- ,4!.1'' ________ Seepage Pit: Distance to nearest well_ _ _____ _.-____Distance from foundation------_-----------Distance to nearest lot line____________.__ i ❑ Number of pits_--------------------Lining material----.------------------Size: Diameter---------------------Depth--------------------------------- essppol: Distance from nearest well-----------------Distance from foundation----------.-------- Lining material__- --------------------------------- ❑ Size: Diameter- -- ---------- ----------------Depth---- ------- --------Liquid Capacity----------------------------gals. Privy: Distance from nearest well______ ___.---------------------------- Distance from nearest building__-__ ___________-____ 0 Distance to nearest lot line----- - -------------------------- ---------------------- ---- --- -- --- ------------------------------------------ Remodeling ----- -------- -- ---- Remodeling and/or repairing (describe):_V(STEM--._IN6TB4-A-F-D_______ ------/SSVRNS ------PP-____PFR =' --------------------------------------------------------- -------------------------------- ----- ----- ------ --------- ---------- I ------ ------------------------- -- -------- --------------------------------- -------- ---------- ------------ ------- - - -------- ------- -- --- ----- ----- -- ----------------------- --------- - ---- ----- - --- -- - ---- - Ra p 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 ruleA and regulations of the San.Jtoaquinlocal Health District. .:(Signed).,. -- - --- -- ----- ---- --------(Owner and/or_Contractor) G 1y - - -----(Title)--- -------- --------- - - (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 j APPLICATION ACCEPTED BY----------- -- ------------------- ------ ----------------- DATE- - =--3'-- -------------- -------------- REVIEWEDBY-----------------------------------------_ --------- --- ---- -- ---- ------ ----- ---------- DATE--------------------------------------------------------- - BUILDINGPERMIT ISSUED-------------- --- - ---------------- ------------- ----------- --- _.._ DATE------------------------------ -------------------- Alterations and/or recommendations:---- - ----------- - ---- ---- ------------ -- ----- - -------- ----------------------------------------------- ----- ----- -------- ----- ------ - -- ----- ------- --------------------------- -------------------------------- --------------------------------------------------------------------------- ----------------------------------------------- -- -------____- ... ............ - ___ _ .__ -____-._ --------- _ _._. _ ------------- _ -_ __ .__ --------------- _ .__ ___ ._ _ _ __ _ _- _ __ .__. __ __ ____ _ _____ _______ ______ _ __._--._ - -.____-_-... _.____ ________.____. _- _ ___-._ _________ FINALINSPE ION BY: - - - - ----------- -- - --- - -------- Date------- - ----- -f7.'3 ---------------- -•------------ rc SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stoddon,California Lodi,California Manteca,California Tracy,California M t.'