20304 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: ___--y.' -.--_-____, APPLICATION FOR SANITATION PERMIT Permit No.g.eZ�- .J6. (Complete in Duplicate) 1--------------K ....-_...-. This Permit Expires 1 Year From Date Issued Date Issued _ --_1-�_�� 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 . 549. JOB ADDRESS AND LOCATION.......17-4)_1------ --------------------------- Owner's Name--- .. -/--- • -- ------------ -- - ---•------------- --- ---------------- Phone. lAl�`-4._` r� i � Address....... f 5 ... . -- -------- Contractor's Name------- ----- Phone. 4l Installation will serve: Residence ❑ Apartment House [] Commercial Trailer Court ❑ Motel ❑ Other ❑ l Number of living units: -------- Number of bedrooms -------- Number of bathst/- -- sixe ------/57- -t .s_9------------------- Wafer Supply: Public system Community system ❑ Private ❑ Depth to Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe U' Hardpan ❑ Previous Application Made: (If yes,date......... -----.....) No gal" New Construction: Yes �o ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if ublic sewer is available within 200 feet.} i Septic Tank: Distance from nearest well -.-----_------Distance from foundation--,Q----.---- Mate'iai-) Septic No. of compartments.....CT----_-----.----S'szeAAt_)(.5/f.---Liquid depth__-- .____... --------Capacity_!AQ_Q__ Disposal Field: Distance from nearest well.-/va!w Distance from foundation---/Q-__------Distance to nearest lot line--s_-.---------- Number of lines-------_---_-___ Length of each line___/Ad Width of trench---- ._ i �r Type of filter material- Ck-___Depth of fiiter material------ if.--..-.Total length-------- ---------/--D-------.--. . i E Seepage Pit: Distance to nearest well_-�Jh -----Distance.- foundation--- ------_--.Distance to nearest lot line--.-- ------_ Number of pits------ --------- Li--_-___Size: Diameter..-- ` e -----Lining material._ D.G �-�-- - ------.Depth----o2-�--------------------- ` Cesspool: Distance from nearest well--------------__Distance from foundation....................Lining material--------_---_-_._.______--------_. \` ❑ Size: Diameter----- --------------- ----------------Depth----------------------------------------------------Liquid Capacity--- ----------------------..gals. Q Privy: Distance from nearest well-------------------------------------------------Distance from nearest building---------_---_------------------.-.----.-. ❑ Distance to nearest lot fine- --- - - -------- - ------ -- ---------- - --------------------------------------------- ---------------------------------------------- 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 ordinances, to laws, and rule and gulations of the S Joaquin Local Health District. (Signed)- _____________ _ _____-__-.. -.- ---- -------- .---- --.-..--.- . . Owner and/or Contractor , 9 -------- -------- ----- { / By:------------------------------------------------- ----- ------ -- ------- �------------------------ ......... .......... (Plot plan, showing size of lot, location of system in relation f ells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---------------------------------------------------------- DATE-------- ------ REVIEWEDBY---------------------------------------------------------------------------------------------------------------------------- DATE----------------------------------------------------------- BUILDING PERMIT ISSUED----------------------------------- ------------------------------' ---- ----- r DATE-----------_---:----------------------------- Alterations and/or recommepdafions:--------- ]) y- Z' r' (,---'-' r �' ' ' ` ~`- - -- �( ------------------------------------------- -------------------------------------------------------------- -----------------------------------------------------------------------•------------•------------------------- -- ---------------------- -------' ----------------1 ''-'-'--' ------------------------------------------------ ------------------------- --- ------------------------------------------------------------ FINAL INSPECTION BY:----- --- C— ---------' ' - ------ .- Date- C----------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO.