18597 - Laserfiche WebLink

Home Browse Search

t•UK Ul-M-t Ust: Y qq r7 APPLICATION FOR SANITATION PERMIT' Permit No. .l_�.W7�!_./_ ---------- - --- -------- -- ---------------------------- (Complete in Duplicate) -' -- -' This Permit Expires. 1 Year From Date Issued "'"""' Date Issued Application is hereby made to the San Joaquin Local Health Di 'ct for a permit to construct and install the work herein described. -14-This application is made in compliance with ounty Ordinanc "549. JOB ADDRESS AND CATI N- _ -==_�-____ _'�`----'-•------------ Ll "'-�a..A_ -----r-------------------- --------------- Phone- -77-4 _. Owners Name--------- ----------- - �---------------- --------- - Address -- 1 `--j� Contractor's Name------------------- G ---f--- ------- - Phone w. _�fP_Oy _.._ ------------------------------------------ Installation'will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms _-_ Number of baths _'�/__ Lot size / -- - Water Supply: Public system ❑ Community system ❑ Private X Depth to Water Table 10- ft. I Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam X Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date---..---------------) No % New Construction: Yes ❑ No �Z FHA/VA: Yes ❑ No jK 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____-_--_------------------------- ------------ ❑N- t �y No. of compartments-------------------------Size---------------•------------:---Liquid depth ----------- - --------Capacity----------------------- Disposal Field: Disfance from nearest well__.- ______Distance from foundation- G-- -_---:Distance to nearest lot line___lee r. Number of lines_. 1` _C -____ Length of each line---- g ri; Width of french-___ r _ ior Type of filter material-(-•-__.__��_-_��_ __Depth of-filter�material__�.___-_--_--_____-.Total r Type f 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__._. --- __._-_.:.__._.___.__..__.. ❑ Size: Diameter-----------------------------------E_Depfh------------------------------- -------------------Liquid Capacity----------------------------9als.�} Privy: r Distance from nearest wail_-----------------------------------------------iMsfance from nearest building ❑ Distance to nearest lot line-----------------_--_ � ----------------------------------- - I # . Remodeling and/or repairing (describe): ---------- ---L/" ''u---0----------•---------------•---------------•------ - ' ----------------------------------------------------------- -- ----------------- ' ------------- - --------------- -------------------- --------- ---------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------- I hereby certify that'l have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State la , an ules and reclul4tions of the•San,Joaquin Local Health District. i (Signed)----------------------------- ---------------- --- - -- ---- --- ---------------- --- -----:------- ---- -Owner and/or Contractor BY: tx ----- Title .- ) . (Plot plan, showing size of lot, locafisn of system in relation to wells, buildings, etc., can be placed reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------d CY , 2. s c�----------------------------- DATE -'--------------------- REVIEWEDBY----------------------------------------- -------- ------------------- --------------------------------------------------- DATE----------------------------------------------------------- i BUILDING PERMIT ISSUED-------------------------------------------------------------•--------------------------------------- DATE Alterations and/or recommendations:._-_---._..-._ - -- - - - -� - -':-_-_-.-_-- j ---------------------------•------------------------------------------ -- -------------------------------------------------------------------•-----------•---------------•------------------------• ---------------•---------- --------------------------------------------------- -------------•-----------------------------------•----------------------------------------------•--•---------------- ------------------------------ -------------------- -----•------- -----•----------------- -- ------ ----------------------------------------------------------•--------------------------------------- --------------------------------- / _ FINAL INSPECTION B ..` -- --- Date ------- _6 �T --------------- SAN JOAQ LOCAL HEALTH DISTRICT 1601 E.Haielton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca, California Tracy,California F.F.120. ` f