20722 - Laserfiche WebLink

Home Browse Search

~ FOR OFFICE USE: j ---- -------- "------------"--------------------" APPLICATION FOR SANITATION PERMIT Permit No. - ------------------- ---------------------------------- (Complete in Duplicate) Date Issued - -- ---------- ------------------ - ----- --- - " ---- This Permit Expires 1 Year From Date Issued nd install the work herein described. Application is hereby made to the San Joaquin Local Health District for a permit to construct a '�e�` a This application is made ' om ce wi h County Ordinance 5 r 2 '� '� JOB ADDRESS AN ATION Phone Owner's Name ---•----------- ---------------- - - -�` ------------------------ ----------- - Address__ o ----------- Contractor's Name____________ __ ______�-�-Q ----------- Installation will serve: Residence Apartment House ❑ Commercial' ❑ Trailer Court ❑ ❑ " Motel Other ❑ Number of living units: ___�__ Number of bedrooms _X- Number baths Lot size._-_� . �-------------------------- N . s stem Community system [� Private pth to Water Table ----_--- ft. �! Water Supply:�Publicsy p„ _ Hardpan Character of soil to a depth of; feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑F FHA/VA.. Yves ❑ No ❑ Previous Application-Mad e:"-I�Ifyes;date--_.----" ------1 No ❑. New Construction: Yes ❑ No ❑ �TY-PErOFANSTALLATION-AND SPECIFICATIONS:. .-� (No septic tank or cesspool permitted if public sewer is_available within 200 feet.) Septic Tank: Distance from nearest well t---------------Distance from foundation-------------------- uid depth_ Material -_: _Capacity----------------------- ❑ No. of compartments----1--------- ...... '--Size----------------- - - 9 Dis o Field: Distance from nearest well-_-.-�� /Distance from foundation__.__-��-_-�--Distance to nearest lot line.____f---. p Length of each line_________ -p Width of trench.-...�------------------------- --------------- Number of lines g t� Type of filter material-------9RI- !.-.__-Depth of filter mater aI____._ -� ----Total length___" ------------ 1. Seepage Pit: Distance to nearest well_____________________Distance from foundation--------------------Distance to nearest lot line__________.__-__ ' ❑ Number of pits..- Lining material -- Size: Diameter---------- ----- ---Depth--- Cesspool: Distance from nearest well-----"----_-__._-Distance from foundation--------------------Lining material------------------------------------ Cesspool' -.------_-__---__------------- --- --..........Depth------------------ ? - -------Liquid Capacity-- -------------------------9 Size: Diameter---------------------------- 'I - ------- "----- ----- - Distance from nearest building ---------------------------- -------- Privy: Distance from nearest well ----------------- - l ❑ Distance to nearest lot line--------------------------------------- l Remodeling and/or repairing (desaribey:_..._ ' -G�- -----j i / --------------------- -- + ---- I ---------------------- ------------------ ------------------------ --- ---- - I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State k and rules and regulations of the San Joaquin Local 1.Health District. Y Y n ar on roc or ----- --------------------------- (Signed) ----- ------ --------------- By:----- - - �. ------(Title} �,. -_ _ ______ ___------- (Plot _______ __ ' (Plot plan, showing size of lot, location of system in r ation to wells, buildings, etc., can be placed on reverse side). t FOR DEPARTMENT USE ONLY -----" ------ --------- --------------------- DATE----- ---�--�"-- ------------------------------ t APPLICATION ACCEPTED BY_ - DATE---- - -------- ----------- ------------ ---------------- REVIEWEDBY--- --------------------- ------- ----------- --------- --------------------- ----- --- --- - BUILDING PERMIT ISSUED--------------------------------------------------------------------- ---------------- Alterations and/or recommend atiohs:__._______________"-----"----------- - ------------------- ---•--------------------------------- --------------- -- -----------------" -------------- f Da -------------------------- --- to-.. . `�-� ----------'- ... ------------------------------- - FINAL INSPECTION BY:, SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.liaxelton Ave. 304 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracyr California F.P.CU.