21757 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: �� it No. ..�� APPLICATION FOR SANITATION PERMITPerm ----------------"------ -------------.._..-- _ - -------------------------------------------------------- (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 construct and install the work herein described. This application is made in compliancb with County Or finance No. 549. 7a3 OAC -------------- ------------------------------- JOB ADDRESS AND LOCATION :4---- Owner's Name 17- ------ •-�-,-/ , ---------- Phone------------------------•"-----•---- ' /�l yy�q106 ---------- --------------- Address------ 'ZI r,/ ' •5,.--------•------------------------------------•"----------------------------------------------- -----•---------••---•---•-------•---------"-- �/ Phone----------------------------------- Contractor's Name---�"�`-- ------"-------•-----"---------- ---------------•-------- Installation will serve: Residence [i�partmenf House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ 1 Number of living units: __�_--" Number of bedrooms �: Number of bathsLot size - ------------------------------ Water Supply: Publics Y r, stem Community system [-] Private ❑ Depth to Water Table I a yes,date of soil to a depth of 3 feet: Sand F1Gravel Q S. Loam ❑ Clay Loam [I Clay [-] Adobe Hardpan ❑ # L7�/ Previous Application Made: {1f ate--------- ----__-..} No New Construction: Yes El No FHA/VA: Yes ❑ No Lh' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.)' �[•� � I t Septi nk: Distance from ne1arest well----"---_---_.-_Distance from fo,undation-------------"___-.Material------__--"_"-_-. .-..---_-----..-_-_----. -. No. of compartments Size------------------- t Liquid depth-- --------------- -- ----Capacity---------- ---------- Dispo ie Distance from nearest well...~-------Distance from foundation_._�b-s._.-__--.Distance to nearest lot line_-._______. Number oflines{------1-------------------------Length of each'linea_0-----------------------.Width of trench--- --- -`------------------- Type of filter material__` G __--_Depth of filter, material-A -_-_--_...__Total length--------- o------------------------- r / Seep �t: Distance to nearest well-- --------------Distance fpm foupdation---_J0---_--___.Distapce to nearest lot line_-p_-___ C C ------- Number of pits...(_:.--"-.--------Lining material--_----�--<?G-----Size: Diameter-_..c1- ----.-----"--Depth------ ------- I __ Cesspool: F, Distance from nearest well_________________Distance from foundation- material____..._.____---------------"- als. Privy: Distance from ❑ Size: Diameter----------------------------- ------Depth-------------------------- ---------------------Liquid Capacity---------------------- 9 _-"Distance from nearest building nearest well g ❑ Distance to nearest lot line------------------ -------------------- --------------------------------------------------- - - ------------------ Remodeling and/or repairing (desclibe):------ - --- --------------- ------------------------------------------------------------- ---------------- -------------f'------------'---•----------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------- ---------------------- hereb certif that I have p ------- ------ -- ------------------------- ----------------------------------- ------------------- ---- --------------------------- ordinances, State laws, and rul aepared +his application and that the work will be done in accordance with San Joaquin County nd regula+ions of he an Jo quin Local Health District. Si ned --------------------------------------- {Owner and/or Contractor) ------------------------------------- ---------------------------------------- (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 OR APPLICATION ACCEPTED BY DATE- -5� -- -- ------ ----------------------------------- REVIEWED BY---------------------------- ---- DATE BUILDING PERMIT ISSUED-------------------------- - ---------- DATE Alterations and/or recommendations:------------------ -- ----------------------------------------------------------------- -- -•------------------------ ------------------------------- -------------------- I ------------------------------------------•-------- --------------•- -•--------- - - ------ --- --------------- -- -- -------;-------------- --- ------- FINAL INSPECTION BY:..- 40----- - Date.... f----- 3`--------- - -------------- ---------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:ellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street 1 Stockton,California Lodi,California Manteca,California Tracy,California F.P.Ca. I