14281 - Laserfiche WebLink

Home Browse Search

.... ..... --------------- ---------- APPLICATION FOR SANITATION PERMIT Permit No. ..--f (Complete in Duplicate) " - This Permit Expfres 1 Year From Date Issued Date Issued .._.'r_ 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. V- - . JOB ADDRESS AND LOCA_TIO.N...�_ __j . �----------------- Owner's Name....Ci ------- -•---------r ------------- ----------- --------------------------------------- .--- ----- Phone....... cAddress............. - - --------------......................................................................----- ----------••----------•--- Contractor's Name'`._ __--_- '1 J"'S------- --- Phone .................... Installation will serve: I Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units. .__/__. Number of bedrooms _ -- Number of baths ..�.___ Lot size Water Supply:t Public system ❑ Communitysystem y ❑ Private &"`Depth to Water Table,3_,p_ 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-l/-l -,S`y_J No ❑ , New Construction: Yes [il. No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or,cesspool permitted if public sewer is available within 200 feet.) p Septic Tank: Distance {rnearest well: Distance -f-ound+ion___I _r _.__.._. ZCriNo. of compartments_.__ .Material._ Size--- L •---- iquidCapacity depth----t." ` Ca aci Disposal Field: -Distance from nearest well-4Q-------- p ty Distance from foundation..f._j_-.__---.Distance to nearest lot line.�.......... Number of lines__..____-- -"- "--,---,•_Len fih of each line_.__ o -��--� gra •E� .,Width of trench__` Type of filter material.-._.Lsc? - -------Depth of filter material___13' " ----•----Tota I length----- '----•��---a.'..--------• 5eepaq.9"Pit: Distance to nearest well___: _ -------Distance from foundation_-_-.__ _s :DIS+SnCe to nearest lot line__... _._--- UN Number of Pits------------o.......Lining material__.___-Size. Diameter__.. . ��'`----..,Depth-------2.�--�----•------•- Cesspool; Distance from nearest well________________ � } _Distance from foundafion___-_-"---.-•-�--•".Lining material___._""_.._____•"-_--__--••----•---__ (� ❑ Size: Diameter----- --------------------------------Depth---- I--••-Li Liquid Capacity `l ------- -- gals. Privy: Distance from nearest well____ _______________ Distance from nearest building Distance to nearest lot line --_-----_-_ ----------------------------------------------------------------•-----•---. ------- Remodeling and/or repairing (describe)_-----------------"___--- ---•-----------•------•--------•----------------- ---------••--------------•----•--------------------•-----•---------•------•---•-----•----•------•------•-------•---------•-•-------•-•---•-----•-----•----------- I hereby certify that I have'prepared this application and that the work will be done in accordance with San Joaquin County o41oances, State laws, and rules and regulations of the San Joaquin Local Health District. i (Signed)------------------------------....................... --------------------------------------------------------------(Owner and/or Contractor) By:----------------•--------_------- •------- ------ --- -----•----------•-----------•---------••-----------•---(Title)-------••-------------------11-----• � �--------•---- (Plot plan, showing size of to , oc stem in f elation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------------- REVIEWED BY 111 11 fir"'"---------------------------------- DATE--------------------------------- �`- /� ------------- ----------•---...-- - --- ------------------------------------BUILDING PERMIT ISSUED -- DATE----- •-•--------------- -•-----------------.• - AFFerw ----------• - _..____- atio s an m -•---- ------------------- ---------•------------------------------•----------•- - ns: g ` --------------------•------ - � --- � ------------------------------------------- ----------- ' ------ ---•------------------•---------..._.....--- ------ ----------•-----------••----------•---------- ------_------. •.......--------- ---- FINAL INSPECTION BY---------- --- Date_ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Streeti 134 Sycamore Street Stockton,California205 West 9th Street Lodi,California Manteca,California EG"9 REVISED B-$9 2M 0-61 ATLAS Tracy,California t fi