20804 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: _ .r- Permit No. --' � APPLICATIONi' FOR, SANITATION PERMIT ------------ --------- ----- ----------- ---- ----- �,i (Complete in Duplicate) Date Issued ----------------------- ------- This Permit Expires 1 Year From Dade 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 compliance with County Or inane% No. 549.� JOB ADDRESS AND LOCATION.....__ _ (f� ---------------•----- ----- ------------------------------------ 'i 1WL Owners Name----- -- - -- --•- •- - ------ --• - 1-11 ----- -------- Phone R Address- --------- ----- ----- ----- Phone� �1n�� Contractor's Name----------- -- --------------- „= ---------- -------- --------- t Installation will serve: Residence 4Apartment House ❑ Commercial ❑ Trailer Cour} (I Motel ❑ Other El 1 Number of living units: _I Number of bedrooms -�-- Number of baths j._- Lot size ---------------------------- Water Supply: Public system [community system F1Private ❑ Depth to Water Table t• Character of soil to a depth of 3 feet: Sand ❑ Gravel F1 Sandy Learn'[] Clay Loam El No ❑ Adobe[5--Hardpan C] Previous Application Made: (if yes,date_- ----------------) No [ New Construction Yes E] No © FHA/VA: Yes ❑ No ❑--- PP TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Material--------- ------- --- ----------- ---------� Sep isLank: Distance from nearest well'-------- -----_Distance from foundation-------------------- Capacity_____._________.__ .- i 7*No. of compartments----- --------------------Size-----------------------•----_-- Liquid depth--------- -- ----------. Disposal Fie Distance from nearest well..`r'_____.-Distance from foundation---/ ----------Distance to nearest lot line----- -_.- I Number of lines____ _ : � Width of french------ `--"____------- rr � -"--_-- --Length of each line_-t ----- - W i ------------ i Type of filter matenal_�� LA .-_Depth of filter material_._L-�.- ------Total length____..�___,C�__..________ nearest lot line----------------- Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to ❑ Number of�pits ------------- -------Lining material-------------- -- -----Size: Diameter__------------ -----Depth-------------------------------- F Cesspool: Distance#from nearest well-----------------Distance from foundation_...__---.-.._._._.Lining material__.-.----------------- als. ❑ Size: Diameter- --------------- --------- --- ------ Depth----------------------------- ----------------------Liquid Capacity g Privy: Distance from nearest well---------------------------------------------------- Distance from nearest building----------------------------------------- ❑ x . , t ------------------------- --------------- - ----------------- Distance to nearest lot line............._.__ -- --------------------� " Remodeling and/or repairing (describe):--------------- ---------------------------------------------------------------------------------- ----------------- --------- 9 ___________________________________________ ________________________I-_---_------_-__-_-_----__------_----_ . ----------------------------------------------------------_ _ _-__-___ ith San Joauin q County I hereby certify that I have prepared this application and that the work will be done in accordance w ordinances, State laws, d rules and regulati ns of the San oaquin Local Health District. ; •----------- ----(O (Signed) caner and/or Contractor) -R” Title - (Piot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED B _ _ ----- ------------- DATE----1-A7-4 .. REVIEWED BY----------------------- ------------- -------------- DATE----------------------------------------------------------- BUILDING PERMIT ISSUED----------------------------------------------------------------------------------- -- -------• DATE---- ------------------------ ------------------------------ Alterations and/or recommendations---------------------------- ----------- ---- ---- -----•------ -----•-------------""""-- ------------ ------------------------------------------------- - F ----- -------------------------- - Date..... 7 `_ / ------------- FINAL INSPECTION BY:----- ----- ------------- - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO.