22195 - Laserfiche WebLink

Home Browse Search

--FOR OFFICE USE: -------------------------- ----------------------------------__........... APPLICATION FOR SANITATION PERMIT Permit ��- ---------- ------------------------------------------ (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 co uc ad 11 e or herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS LOCATION..... "//! `- 4 ----------- -------- Owner's Name----- ---- - ---- Phone--O. -----•-- ----- ---------------------------- -------------------------- Address----------------A=� j -- -- - ----- Contractor's Name. - - - ?R-j- � Installation will serve: Residence par tment"House ff. ommercial ❑ frailer Court ❑ Motel ❑ "Other ❑ Number of living units: , _ Number of bedrooms -- ---- Number-of hs-3--- Lot size ----- --- ----------------._.___.__ --------------------- Water Supply: Public system ❑ Community system E] Private Depthto ter Table ------ _ 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-_-__-_--_-.-.. l No ❑ New Construction: Yes ❑ No 9 FHA/VA: Yes ❑ No E]TYPE OF INSTALLATION AND SPECIFICATIONS: J \ �1 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation-------------------Material ._.._._-._-.-..--.---_--.-------__._..--__---.-. ❑ No. of compartments----------- ------------r Size---------- --------- -----------Liquid depth-- ------- ------- --- - Capacity----------------------- �s--� Disposal Field: Distance from nearest well......... .....Distance from foundation----!_©....-.Distance to nearest lot line----C57-____- ❑ Number of lines--- .-Length of each line_- ---------------------------Width of trench_�--;____y ;� -._...___- Type of filter materi ____ ____- --Depth of filter material-__ �� Total length-------y `�-_-•----_--_-- - Seepage Pit: Distance to nearest well---------------- ----Distance from foundation....................Distance to nearest lot line----------------- ❑ Number of pits.-- -----------------.Lining material--._---__-_-_-__- Size: Diameter__-_-----------.......Dept h_---__-..______--.__-.-._.... 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 ( r -------------------------------------- --------------- ---------------------------------------------- ... - ------------ ---------------------------------------- ------ ------------------------------------ ----- ---------------------------------- `----------------------------------------------------------- ---------------------------- -------- -- -------------------------- ----- ---------------------------- ----- I hereby certify that I have prepared this application and that the work will a done in accordance with San Joaquin County ordinances, ws, d rules a egulati ns o Sa a uin Lo I He _ District. 1 1 (Signe ._ ----_ - --- -- ---------- ------- ---- ---- - _'------- --------------`-ClvX9rraad/.or Contractor) By:-------------------------------- -- --- - (Title)---------- ------ -------..------------- --- ----- --------- (Plot plan, showing size of lot, location of system in relat' to wells, buildings e1c., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- --- = - ------------------- ---- -----------------•---------------------- DATE_- r��-?_' --------------------- REVIEWEDBY------------------------------------------------------- ---------- ------ -- ----- -------------------------------------- DATE-------------------------------- - BUILDINGPERMIT ISSUED---------- ------- ----------- -------------------------------------------------------------------- DATE------------------------------------------------ Alterations and/or recommendations------------------ - ----------------------------------------------- -------------------------------------------------- ----------------__............... ------------- ------ -------- --------------- ------------------ ---------------------------------------------------------- ----- ------------------------------------------------------------------------- ------------------------ ------------- ----------------------------------------------------------------------=----------------------•--------------------------- -. ------- ---------------------------- i FINAL INSPECTION BY:-�.� R ----------------- Date-jr -- - 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 E.H.9 2M 1.67 Vanguard Press