14275 - Laserfiche WebLink

Home Browse Search

FOROFFICE QSE.' ----- --------- __ ________________________ APPLICATION FOR SANITATION PERMIT Permit No. --------------------------------------------------------- . (Complete in Duplicate) S . Date Issued ------------------------ This Permit Expires 1 Year From Date Issued ..... .. ./. ...G �� 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 Ordinance No. 549. JOB ADDRESS AND LO CATION--- �� ••is�� $� ------------------------ I.............. ` Owner's Name ----------------------------------------- Phone.................................... Address--.------� - -------------- ---------------------- -- ---- -- Contractor's Name ~ .......................•_... Phone................................... tnstallation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _Z___ Number of bedrooms / -__ Number of baths /-___ Lot size ��,XlXa................................. Water Supply: Public system f pp y. y Community system ❑ Private ❑ Depth to Water Table _��ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date---------------_----) No New Construction: Yes ❑ No U?' FHA/VA: Yes ❑ No �-- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: _» Distance from nearest well____'_-__--Dista��fom foundation-----,�4------- Matvial...( f .�,fl. ...•..._... [L" No. of compartments--___e2.......:........Sizerr� P?___--_-Liquid depth__,%�O,/-----------Capacity.._,gF Q0 ......_ Disposal >Id: Distance from nearest well--'--— Distance from foundation....40-7.�.....Distance to nearest lot line-_s0_ *.-.... G9/ Number of lines---... ./- _________ _Length of each line----,�V__-__________:_.Width of trench__ _._------------- Type of filter material,, - �-Depth of filter ma#erial____ -._.-_Total length_____ _�_________________________ Seepage Pit: Distance to nearest well--------r ----------Distance f om foundation-----44--------Distance to nearest lot line..-----_____ ®0010, Number of pits--.-./-------------Lining materiai_XP& ___-Size: Diameter_ _____ Depth--- -_d7./_._.....________ \ Cesspool: Distance from nearest well____•----__.._._-Distance from foundation_____________ �_--.Lining material-------......-_._........___.____-_-_ ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity------------------------_-gals. Privy: Distance from nearest well--.------------------------------- ---- -------Distance from nearest building----------------------------------------- C3 Distance to nearest lot line__________________ __ -- ------ RemodelingRr and/or repairing ______________________ -----------------------------------------------------•-•----•------•-----•----------------------------------------------------------------------------------------------------•--•-------•----- ------------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws,dandlesand regulations of the San Joaquin Local Health District.Si ned r( •9 ) --- -. . . --( -a%dAr Contractor) By----------------------------- - --- (T1tle),0eA,11Z (Piot plan, showing size of lot, location of system i elation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTEDBY-- �.. � ---__•------------------------ DATE-------�.:1_ -__� ---------- REVIEWEDBY--------------- . --...---------------------------------------------------------------------------•-------------- DATE-------------------------------------------------------- BUILDINGPERMIT ISSUED........-------------------------------------------------------------.......I------------------------ DATE------------------------------------------------- Atterations and/or recommendations:_____—"j�__ - . -._____._ r ___ _ __-.S'__ ••---•------------•-----•-----------------------------••-----••--- •-----------------------------------•-••-------------------------------•----------....-.---------------------------------- ............... ----------------------------------------------------------- .................... ------------------------------------------------------•-•-- ---------------------------------------------------•----------------------------- ----------------------------------------------..--•-------------•-•-•------------------. -._-----------------------------------------------------•--•--•------------------•-••----....----------••-•-•--------_--- ..-------- ------------------------------------ ---- --------- FINAL INSPECTIONBY. y ,�(.,.-.�,.�..--.. ��,,....�� Date------------------s-�-----/_a'-.`� Z--------•--- -••---•------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Strout 300 West Oak STreet 124 Sycamore Street 205 West 9th street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-99 2M 6-81 ATLAS f