19189 - Laserfiche WebLink

Home Browse Search

�FFOR OFFICE USE: { t iel ��s 'S' ALI ---------- ( $ APPLICATION FOR SANITATION PERMIT Permit No. 1. 1 .�-.--- ----------- - --- -- ---------- (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 Ordinance No. 549. JOB ADDRESS AND LOCATION_ 4_ _�— �`� v!/ Phone------------------------------------ Owner's Name----r_ a,?,v ------- ----- --------- ------------------- Address--------------•. -----...- ---- ------------------------------------------------------ ---------------------------- Contractor's Name_ ` `_4 71- ---- --i------------------------------------------------------------ ------ Phone-------- ------•--------•---------- Installation will serve: 'Residence (Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ I Number of living units: r"�__ Number of bedrooms _- .-_ Number of baths _ .___- Lot size ---------------------------------- -------------------------- Water Supply: Public system [Community system [IPrivate E] Depth to Water Table -- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel [I 'Sandy Loam E] Clay Loam [IClay E] Adobe Hardpan ElPrevious Application Made: (if yes-date_--.__-. �-"---- ) 'Nb.e! •' New Construction:'Yes [D No HA/VA. Yes No [I t, TYPE OF INSTALLATION AND SPECIFICATIONS: lNo septic tank or cesspool permitted if public sewer is available`wi+hin 200 feetIf.) r kMaterial_ G---O-_--- ._ Septic lank: Distance from nearest_well-_ _ ______Distance from foundationI -Ca Capacity - No. of compartments__ _ 5'X.1---Liquid depth----- __ ___________ Size _..'_.. t Disposal.Field: Distance from nearest well_._'..`r-__-.--Distanee from foundationf_ #_-.____-_.Distance to nearest lot line,r..._._____. Number of lines-__-1--------_------ -----------Length of each line--4b--------------.......Width of french---;.'. -`---..--------------- Type of filter-material ,? -I---- --------Depth of filter material____Ir-----------Total length__-__.__4_,0------------------------- { .• Seepage,Pit: Distance to nearest well---__.~-----------Distance om foundation__��____________Dis3ta ice to nearest lot ii�er-----__________ ,�. --- ----Depth-----4- ------------------ N Number of pits._.____------------Lining material, -_-� :(�-G-I-1_-_--Size: Diameter-_.3______. a r rom foundation_.-._.-------------:Lining material____.._____-__.______.-_--.____als Cesspool: Distance from'nearest well_________________Distarcef�f . rn F1 Size Diameter----- -------------- ------- - -----Depth------------- --------------- ---------------------Liquid Capacity---------------- 9 --- -----.Distance from nearest building Privy: Distance from nearest well---- -------------- --G-'1 ------- �. ❑ Distance to nearest lot line- ------------ - �..i.t --------------- --- ------------------------- ------------------- I Remadelin and/or repairing escn ----- ------------------------------------------------------------ ----------------------------------- --------------- = -------- ------ - = I hereby certify that I have prepared +his application and that the work will be done in accordance with San Joaquin County ` ordinances, State laws, and rule and'regulations of the San Joaquin Local Health District. _--- ----------------(Owner and/or Contractor) Si ned - BY� ............................................................... -- - -- -- -- - ------------ ----------- ------------(Title)---------- --------------------- ---------- .----------------- --- ------ ------ d (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). f FOR DEPARTMENT USE ONLY DATE_ . APPLICATION ACCEPTED BY " REVIEWED BY------------------------------ --- -------- --------------------------------------------- DATE---------------------------------------------------------- f BUILDING PERMIT ISSUED------ •------------------------------------ ----------------------------- --------------------------- DATE------------------------ -------- -------------------- BUILDING -------------- - -- Alterations and/or recommendations--------------- -------------------------------------------- ----------- -- ---- ----------------------- ----------------•------•--------- - I ---------------------------------------------- i ---------- ----------------------------- ------------------------------------ C/ -. Date-_ - - p'� FINAL INSPECTION BY:.-----, -�-=------ --------- --------- - ---------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.14aielton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CG.