19626 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: b� '02. Permit No. � � APPLICATION FOR SANITATION pERMtT r- --_ (Complete in plicate) Date Issued` --------------------------------------- r_.__. This Permit Expires 1 Yea- rom Date Issue 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 comphance!with County O:;&e ince No. 549. s ----------------------- Q - ------------------------------- -----•----•----------- JOB ADDRESS ANDPC TION.____ t7------ ------o -• Owner's Name-- ---••----------- -------- ------ Phone---------•-------------------------- Address----- = ------------- - ------------------------------------ --------••-----•-----•---------- •----------•- - - --------- - -- Phone----------------------------------- Contractor's Name--------- - - ------------------- Installation will serve: Residence �p Commercial Trailer Court ❑ Motel ❑ Other ❑ artment House ❑ ❑ /Lot size tt;� � Number of living units: ; _ Number of bedrooms .- Number of baths - __�-��- --------- ---�- Water Supply: Public system [ Community-system ❑ Private ❑ Depth to Water Table4g 5o Tt I Sand Loam ❑ Clay Loam El ❑ Adobe �rdpan ❑ i Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ y HA/VA: Yes ❑ No Previous Application Made: (If yes,date__..:_`---- I No New Construction: Yes ❑ No �� (No septic tank or cesspool EC mated i public p permitted if public sewer is available within 200 feet.) 4 TYPE OF INSTALLATION AND # I Se tic Tank:y Distance from nearest well _ _____________Distance from foundation__.________-__.__ ..Material_-.---..-_------------- ----------------------- . Capacity... fNo. of compartments---------------------- ---Size-----••------------------------- qup. ---------------- ' O7 - Distance from foundation_. ,>�----.--Distance to nearest to line-Ae------- Disposal Field: Distance from nearest well...____._-._ Width of trench. ---------------------------Number of lines:�._ _ -- . " Length of each line- ----- __ ---Total length__ Type of filter materia -- -Depth of filter mater i ,�1D . __.--Distance to nearest lot Seepage Pit: Distance to nearest weli____:'^�_ — Distance fpm fo ndation__ /✓ Depth_- ------------ ' Cesspool: Distance from nearest well----------------- from foundation--__.----..--_..--.Lining materia _ ala. ------------Depth---------------------------------- -----------------Liquid Capacity---------------------------g ., ❑ Distance from n! res -ell--- Size: D:iameter--,Barest well-------------------------- Distance from nearest building-.--------------------------------------- Privy: --------------------- is ante o nearest - ❑ rest lot'line------ -------------------- -- ------ ------- - - Remodeling and/or repairing desc f t _- --- ----- -- -------------- !-------- ------------_ ---------•----------•-------------------•------------------------- t i-_ ------------------------------------•---------------------------------------------------------------------------------------------- j #certify that I have preparedthisand that the work will be done in accordance with San Joaquin County ! hereby pared this ap I ordinances, State laws, and rules and regulations?f the San Joaquin Local Health District. ( r Contractor) (Signed)--------- --- _ 4_1- __ 6 ---- r k. - - - ------ -------(Title)- By: - -- - -- - - - - ----------------------- --- (Plot plan, showing size of lot, location of system in rel t to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT U5E ONLY APPLICATION ACCEPTED BY----- �'yy � DATE-- = ._ s 5 r-------------- ----------------- --------------------------- - DATE REVIEWED BY------------------------- ---------`---------- -- --------- ----------------------------------------------------------------- DATE -------- - - BUILDINGPERMIT ISSUED------------;---------------------------------------------------------------------- - Alter tions and/or re ommendations:._.________ ____________ L .. f = 4�� - --------------- ----------------------------------------------- t --------------------------------------- -------- -- ---------------- - I FINAL INSPECTION BY:..---.----- �------------------------------ ------- Date-_..- -��-��---�-•� ------- ---- -- ---- --------------- k SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. { 300 West Oak Street 124 Syca< more Street 205 West 9Th Street ? t Lodi,California Manteca,California Tracy,California Stockton,California F.P.C 0.