20874 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: - ------- ----------- --- --- � 11 APPLICATION FOR SANITATION PERMIT Permit No. A�-B'T --------------------------------------------------------- �, --------- -------------------- - (Complete in Duplicate)---------------------- Date issued -�=--------�---- This Permit Expires 1 Year From Date I � 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. r+ Q T Al ---- ' ' �' --•------------------------ JOB ADDRESS AND LOCATION.__sj.°_�._<-T 3� a f fT -� Owner's Name---•---�-111.1-`•-----•-----�+e- `---------------------- _--------------------------------------------- Phone.. N�...?I/.'.`e'_7 Address.............R T-------`-3--------• Q 1'-c------- .............-e��------------------------------------............................................................. Contractor'sf -s- ---------------------------------t------------------------------------------ Ph on e. -2.`7 Installation will serve: Residence ❑ Apartment House ❑ Commercial ®''`railer Court ❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms -------- Number of baths ___Z.._ Lot size -----l.-Z_oi�9.�x....Z,_2-O_-_--_------_ Water Supply: Public system E--Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[A-Hardpan ❑ Previous Application Made: (If yes,date___________________) No ®- New Construction: Yes E- No ❑ FHA/VA: Yes ❑ No E- 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---*a-------Distance from foundation----4 a__•-__._.Material___ ................ Z3- No. of compartments--------?�---------------Size--- _:_..Liquid depth---------�Y__----------Capacity...,£'- Disposal Field: Distance from nearest well.__A/�o----- Distance from foundation-----/_._ ...._._.Distance to nearest lot line...._`........ Number of lines___-____I__________.-----------Length of each line____-_-_g.a__ ----------Width of trench.----2.--'*_.________.____._._-__ Type of filter material ___Depth of filter material-----2_�_�e-____Total length_-_._--<I_____________________________ Seepage Pit: Distance to nearest well----LV_v----------Distance from foundation----/d---------Distance to nearest lot line-_47 0. Number of pits----------/_---.------Lining material_.---9!�!4 47Size: Diameter___.,_ _.......Depth------- _._______._- Cesspool: Distance from nearest well.----------------Distance from foundation--------------------Lining material-------------------.____-____-___._-_ Y, ❑ Size: Diameter---- --------------------------------Depth------ ---------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well---_---------------------------------------------Distance from nearest building________-_______________-_--___._______._. ❑ Distance to nearest lot line---------------------- --------------------------------------------------------------------------------------------------- ------ Remodeling ----Remodeling and/or repairing (describe):----------------------------------------------------------------------------•-----------------•--------------•-•-----------•--------------------------- N -----------------------------•--------------------------------•------------•------------------------------•---•----------•------------------------------------ ------------- ---------- ------ -------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ fi -- --------------------------------------------------------------------------------- •----------------------------------------------------------------------------------------------------------------------- -- 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. f _ __z ________ ----(Owner and/or Contractor) B - (Title)_ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). OR EPARTMENT USE ONLY APPLICATION ACCEPTED BY---------------------- ------ DATE-------------7 �`, � --------------- REVIEWEDBY-------------------------- ---------- ------------------------------------------------------------ DATE------------------------------------------------------------ BUILDING PERMIT ISSUED______________________V _ _ _ __________ D TE_.__.___-__.-_. ---------------------------------------------- �� ------ -- ---------- ------ ---- Alterations and/or recommendations:_-- ---- ' -------------------------- ----------------------- -------- --------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------- --------------------------------- ------------------------------------------------------------ .......... ------- ----------------------------------------- ----------------------------------- ----------- -------- ---------------------- ------ --------------------------------------------------------------- ------------- --------------------------------- -------------------- -------------------- ---------------------------------- ---------- --------------------- ----------------------- ------------------------ --------------- FINAL INSPECTION BY: - - Date� - -------------------- z 3- GC /-- 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