68-90 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: ------------ ----.. APPLICATION FOR SANITATION PERMIT Permit No. _ .. .:. ..... . .............. -------- --------------- -------------- ---------- --------- (Complete-in Duplicate) --..._ This Permit Expires 1 Year From Date Issued Date Issued 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. JOB ADDRESS AND LOCATION--/9-- _ . .r'c1�P,�------ - -- -------------------------------------------- i Owner's Name ` L�� Ic- ^'k`-e:77------------- ------•- -------------- ------- --- ---- Phone------------------------------- Address------------ ------------------------------------------------------------------------•------ --------------------------------------- - ..._..------ t Contractor's Name------ ----- Of v--------- ---- -- - --•--- Phone------ ---------•----------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel El Other ❑ / . ` ' , _/SCS------- ------------ :Number of living units: __ .--.- Number of bedrooms __-_ -- Number of baths-__-__._ Lot size _• _ �-___. ` Water Supply: Public system e-ommunity system ❑ Private ❑ Depth to Water Table ...... _ ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [FR-'Hardpan ❑ Y� Previous Application Made: (If yes,date----------.-------- ) No �New Construction: Yes ❑ No 'FHA/VA: Yes ❑ No'EL-4Q 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 ____...._..______-_..._.__.___.___._. --------- .h kek f 4,f No. of compartments--------------------------Size-------------------- ------- --Liquid depth..------- ------- ------- Capacity----------------------- Disposal Field: Distance from nearest well.... -.--Distance from foundation___. `_ ._.Distance to nearest to linea'____ -Number of lines __.._____ _�_-... -____g_,Length of each line__+��!____ Width of trench. - _________________ 4r a Type of filter materiaffiJ'C:Depth of filter material___/. '__.__------Total length_._ r�__________________________ Seepage Pit: Distance to nearest well_ .......Distance from foundation__.GVI!....Distance to nearest lot line---0_7�__ Number of pits.-- _._!e!-----------Lining mate ria l___ -.cele Size: Diameter__ .X9*$`--- Depth-Al----------------------- r Cesspool: Distance from nearest well ________________Distance from foundation___............. ..Lining material------------------------------.______ ❑' Size: Diameter- -- -------------- ----------------Depth--------- - --------------------------------------Liquid Capacity----------------------------gals. r Privy: D) stance from nearest well__________________________________ ------Distance from nearest building-------_--------...------------..-.----__. f ❑ Distance to nearest lot line - ------------------------------------------ ---------------------__------------------------------------------------------------------- Remodeling and/or repairing (describe}---------- --------- ----- !'1 AV &, -----------.----------------------------------------------- -------- -•---------- ----- --------------------- 1 hereby certify that I 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 Soman Joaquin Local Health District. (signed)...- r/. / ( - _./.,-i--.. - -------(� Contractor) By - ---- +/� --------------------(Title)----&W — ------- - (Piot plan, showing size of lot, location of syst� n relation to wells, buildings, etc., can be placed on reverse side). r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- --- ---------- -------------------------------------------- DATE--- ---------------------------- REVIEWED BY----- - ----------------- --------- - ------ ------ DATE---- .-------- ----- ------------------------------------- BUILDING PERMIT ISSUED. pp ---�- - - - DTE Alterations and/ recommen ations-_A,b - -- ------ ----- - `----- ' ----- .. --- -- - -- ----w- ------------------------------------------------------------` -------------------------------------------------------- -- ------------- --------- --- ---- - ----------------------------- -- ---- ------------------------ f FINAL INSPECTION BY:-.-..`. gp.. -- -- ----------- . Date--- ------I .I- -.-S---------------- -- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 20.5 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California E.N.9 2M 1-67 Vanguard press ih f