20766 - Laserfiche WebLink

Home Browse Search

,..G ------------------------ ------- ----------------- --------------- -- ---------.------------------ APPLICATION FOR SANITATION PERMIT Permit No. = . . (Complete in Duplicate) -------"-"--""--- ------ ----------"---- ----- - Thls'Permit Ez ires 1 Year From Date Issued 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 incompliance with County Ordinance No. 549. JOB ADDRESS A�ND LOCATION_ Owner's Nam ' -- ---- ------------1-1---------------------- T" /I -- - --- P -- -Address--- - - ------ •-------��1_---'-�----------- ---t ------ ----------------- -------------------------------- ---------- ------------------•-------- ---------•--------- Contractor's Name______ �. -'�---.---- -�-� __ " ----------Phone__ _____ ____ _____________ Installation will serve: Resi nce Apartmen House � - ❑� Commercial El Trailer Court E] Motel ❑ Other ❑ !)lumber of living units: .../--- Number of bedrooms"-3-, � Number of baths`_7 Lot size ..___�_".- __ . Water Su I Publics stem Y ❑ Community system ❑' Private X De th to Water Table7, ft. Character of soil to a depth of 3 feet: Sand [� Gravel Sandy Loam Clay Loam ❑ Clay ❑ Adobe•❑ Hardpan ❑ r 9: Previous Application Made: (If yes,}date---_----- _-;.-------) No IxNew Construction: Y TYPE # ` of❑ FHA/VA: Yes [:1NO E.OF-INSTALLATION OF INSTALLATION AND SPECIFICATIONS: OX- (No septic tank ar cesspool permitted if.public sewer is evadable within 200 feet.] x Septic Tank: Distance from nearest well—&;-------Distanced fromfoundafion_ __, ---------Mate ial_.._ - J� No. of com artments" � _ ` p / °--Size_ _ � i uid depth - '. q Capacrty Disposal Field: Distance from near. f well._-7_q__-.-_Distancelfrom founda io c �_-Dist c t rest lot line_ +� - Number of -lines-=- ---- �5 -' � � r -- Length th of each line__ti---- - ...W�th t5T French.--- -� �jl{ Type of filter material_5 � ' gg !T g ---/' e th of filter material___--IS--_----_Total length Seepage Pit: Distance to nearest well.__---_-__----_ ❑ Number of pits-------+= ---Distance from foundation__...__ .____..____.Distance to nearest lot line----------------- _---- _----Lining material-----------------------Size: Diameter_--------------- ----- --- Depth --- Cesspool: Distance from Weare well___=-- -----Distance from founda+ion._________________.Lining material-_---__._--------------------------- ------- ."-.- 4 E Srze: Diameter .. _ = De th " . . ---- -- --------. .�= s_; --.-_ _=--LLi_quid Capacity gals. - --�- '--- --- --- rivy: Distance from nearest welt.... -- � ......-_------------- .......Drs ance from nearest building. ❑ 4 Distance to_nearest I Remodeling and/or repai Ing i3e�lcribej:_�� # p i t --- - ?t 2 � ` �% _-fit �r -rpt r - ` �= 1 ---------- tA ..----•-----•-•---------- --------------------------------------------------------------------7��------------------ r . _ ! hereby certify that I have prepared this application and that the work will 6e done in accordance with San Joaquin County ordinances, Sta laws, and rules and1'regul�i' s offhe San J�aquin uocai.,Health District. a - (Signed)- ,-- -- --- 1 . BY: ��... - ------4--- ------- ---- - --- --- -(Owner and/or Contractor) ` . - -- ----- {Tltle--------- (Plot - plan, showing size of fat, location of system in relation to wells, buildings, etc., can be placed o,Feverse side). • t FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------------- - " = --- ------ DATE REVIEWED BY. � { -, BUILDING PERMIT ISSUED �� ATE " - ---- ----- --- -- = ---------------- --- -- Alterations and/or recQ�nm d ions:- �fC --- ATE-------- �r y/-- JJ ----------- -------------_________________'r_ _._ _� p{.(_ --_ _ _________ __ _._l.el-_ __ �ls, �• -f_..•/A__t_____.. ------------------------- J (J ,f„/__ "Zij� ________________________________ ___...._____-______. ----- -------------------.__.________--__....___.___.._---_-_ - ____._.-. j�F�yy FINAL INSPECTION BY:-_-"------------ - , - , ---------- Date SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F•P.Ctl.