21828 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: ------------ -- -- -- --------- ------------- APPLICATION FOR SANITATION PERMIT Permit No. .. .1 ---------------- - ------ -- ----- - ------ -- (Complete-in Duplicate) -----_.__------------- This Permit Expires 1 Year From Date Issued Date Issued .= do 1-3s� Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein describe This application is rrvcle in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION---_)f.... - .� ��.----� � � Owner's Name---- -------------------------------------- - -- - Phone----•---------------------------•--- Address-----------------Ax--Z------- - ---- --------- op-• -------------------- ------------------------------'-------••------------_----••-------•---•--------_ .. Contractor's Name--=--- ------ -- ---- ---------------- --------------------------•--- Phone----------------------------------- f_..- - Installation will serve: Residence 4 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other E] f Z Number of living units: ----- Number of bedrooms _ =_ Number of baths_ ___.. Lot size . ;_ '1 . Wafer Supply: Public system ❑ Community system ❑ Private M Depth to Water TableJ40- - ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam.] Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ N Previous Application Made: (If yes,date................... ) No ❑ New Construction:' Yes ❑ No ❑ 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.................Distance from foundation-----------------..Material....._.____.....__.____..._____._.__._---- ❑ No. of compartments Size ------- -----------Liquid depth--------- ------- --------Capacity---------- --------- Disposal Field: Distance from nearest Distance from foundation___-�Q.__._.__..Distance to nearest lot line_-S_____________ Number of lines--------I-----------------------Length of each line-- --- -- -------------Width of trench__Af.__�-.------.-.-.----.--- Type of filter material__/06- . Depth of filter material___.J.Q A`____ -Total length__/._11. -'________________________�� Seepage Pit: Distance to nearest well. '-- --___-__Distance from foundatio ____.___._.Distance to nearest lot line'____..._ Number of pits--- ------------------Lining material------.-------------- Size: Diameter------------------ ----Depth._ . ..._.___-------------- Cesspool: ;, Distance from nearest well ----------------Distance from foundation--- ---- Lining material.._-------------------------.----.-- El �l Size: Diameter- __ --------- ----------------Depth_ ----____---_--- -------- . ------Liquid Capacity gals. Privy: Distance from nearest well___---_-----_______________------.--------------Distance from nearest building-------.--------------------------------- . ❑ li Distance to nearest lot line-------------------------------------- -------------------------- Remodeling-and/or repairing ._____--.__-_--------------- -------------------------------------•------------------- -------------------- --------------------------------------- - ---- ----- ----------- ---------------------- -------------- -------------------------------------------------------------------------------------------------------------------------------------------- ------------------------ - ----- I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)------ -4r� f ...... and/or Contractor) - - - ..................... By:--------------------- -------------------------------------------------------------- ------ - --- Title)------ . ............- ------ --- --- ------ --- (Plot plan,.showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY g APPLICATION ACCEPTED BY-- ;-- _- - - -_- ----- - ------ -------------- DATE-- -- ---------------------------- --------- ----------------------------- REVIEWEDBY----------------- ---------------------- - ----------------------------------- ----._ DATE............ ----------------------------------------------- BUILDINGPERMIT ISSUED-------- -- ------- - -- -------------------------------------------------------------------------- DATE--------------------- --------------------------------------- Alterations and/or recommendations:--- ------ --------------- -- ------ -- - -- - -------------------------------------------------•- ------------------- ----•------------- --- - -•--•---------- ---- --------------------------- --- ---- -- --------- ............ ----------------------------------------------------- ------ ------------- .................... -------------------------- FINAL INSPECTION BY: ,� ----- Date.. -------------- -- - - - - --- -- ---- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ifa:elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi. California Manteca,California Tracy,California e E.H.9 2M 1-67 Vanguard Press