16145 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: �� --- --------- APPLICATION FOR SANITATION PERMIT Permit No. =�"--- r T (Complete.in Duplicate) Date issued ____�%. . . .`_ . _._ .--_ This Permit Expires 1 Year_From Date Issued t 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 Ordinan No. 54 ; / 1 JOBADDRESS A �QtO TION _ ,f S� • ------ -----------------------------------•--•------------------ ._..._. ....----------------......-----•---Owner's Name R--------- `` a -- --- Phon ------------------------------------ ---------- Address -----------------------= Address--------------- --------------- ¢ - -' ------. _.._...-------------- ___L- _ _ _______________________________________•-•••• __. _ _ _ ._ ..___ - J I Contractors Name---------------------------------------------------n=Ho ---=--------- =---=- _-` ."".`-- ------�;.•iFhone .. Installation will serve: Residence [�-partme t use ❑ Commercial ❑ Trailer Court ❑ Motel. []: Other ❑ 01 Number.of living units: V Number'of bedrooms _?_ Number of baths -A�Lot size __________________ Water Supply: Public system Commdnity'system ❑ Private ❑ Depth to Water Table4/a_ ft. Character of soil to a depth of3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam p Clay ❑ Adobeo Hardpan ❑W Previous Application Made: Ilf yes,date_�, 1 ;No ❑ New Construction: Yes ❑ No,,K FHA/SVA: Yes ❑ No E::] TYPE OF INSTALLATION AND SPECIFICATIONS: ` E (No septic-tank or cesspool permitted if public sewer is available within 200 feet.) pli ank: Distance from nearest well-----------------Distance from foundation------______�______.Material_._______-__�-__---.-------.---.-------------_--. No. of compartments--------------------- ----Size------•-------------:------------Liquidldepth----------- --------------Capacity-_------------------- is�o a . eld: Distance from nearest well------------------Distance from foundation_____----------------Distance to nearest lot line----------- Number ofilines-----------------------------------Length of each line----------------------- ------Width of trench------------------------------------ Type of filter-material-------------------------Depth of filter material-----------------------Total length------------------------------------------- a r r Seepa Pit: Distance to`.nearest well? 10440--_' m f dation_ _e--------DistanF� to nearest lot lin -Q_______ Number offpits____/_______________Lining materia__ __ _ _ Size: Diameter._, . -----------Depth----- ess oat: Distance from�•riearest-well -------------Distance'f�om"fou'ndation p ",..�`_ Lining material------------------------------------ ❑ Size: Diameter--------------------------------- ----Depth--------- --------------------------------f= _'Liquid,Capacity---------------------------gals. Privy: Disfonce,fr0m nearest well ___________________________________________.____Distance from nearest building------------------------------.---------- -------- . ❑ Distance to nearest lot line_____________________ _ ------------------------------------------------- Remodeling , Remodeling and/or repairing (describe):------------------------------------------------------------------------------ ------ •, -- ------------------------- ' I. , ------------------"------------------- ------------------------------------------------ -------------------------------------------------- --------------------- ----------- ------------------------- �-----------------------------------------------------------------------•----------------------------------�---------------------------------- ! here ce ify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances?a laws; and 'ules a regulations of the San Joaquin Local Health District. [Signed) ------- By =- ------ � caner and/or Contractor) -- ------ -- ---- ---- -- a F BY- "'. t [Title] -------- ------------------------------• .---- -------------- - ------- ---- - -- ------ -- --------------- ----------[Plot plan, showing size of lot, location of.system i relation to wells, buildin , etc., can be placed o reverse side]. i• { ` k :FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED = ------------------------- - ----------------- i - W TE REVIEWED BYDAT-- -- --------------------------------------- �� DI PERMIT ISSUED ATE---------- - ------------- --------------------- Alterations and recommendations: ---•-•----------------------------------------------------------- ----------- _-. - _.{ ________________________________________----_-.-_--__-____.-- ._..._____.._______.__-_------ _-_.____________.___-__---__________________--__-.------ _---_----- --- ----_ ___.______..__.._____..._____________________________ .__.____..__..... ..................... . ------ _..___--__--___ _____.._____ -. _-_ - --________....____. FINAL INSPECTIO - --- - Date_.3_0..... ---- -- -------D�--------------- ---------- AN JOAQUI OCAL EALTH DISTRICT 1641 E.Hazollon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED B-59 3M 3-'63 F.P.CC.