19998 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: �-_ ----------------y -6-?------- p --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ll.. ------------------ -- ----- - ------ ----- ---- -------- (Complete in,Duplicate) o Ft ----------- ----------- -------------------------- 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------4Ql.3, --9Wf ------- -- f-------------- f-----____-- ----------------------------------------------- Owner's Name---- ----------- � $'yls----�- -� ----------•--------------------- --------------------------- ------ Phone----------------------------------- Address--------------45/X0----0j_--- ` . ........ -•-------------------------------------------•----------•---------------------------------------------------••-•---•------------ Contractor s Name-------------- --- Phone--------.--..--.--.-_----__ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ . F Number of living units: A Number of bedrooms _A7. Number of baths Lot size ______________________.__ Water Supply. Public system 11KCommunity system ElPrivate ❑ Depth to Water Table da ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 9-1vardpan ❑ Previous Application Made: (If yes,date__ --- ] No 2� - New Construction: Yes ❑ No in/FNA/VA: Yes ❑ No 9;-- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if pu6lic sewer is availa6le within 200 feet.) _ a Septic Tann,IDistance from nearest well______._.___--_Distance from foundation____._.__________.material------------------------------------------------- e �� l�TNo. of compartmenfis--------------------------Size--------------------- ----------Liquid depth---------------- -------.-Capacity----------------------- i o Disposal F' I4: Distance from nearest well-----""� --_.Distance from foundation__.��- -----Distance to nearest lot Number of lines________ ______ length of each line___ '�__ Width of trench_.. `__________..____.___.___ Q Type of filter material Depth of filter material_.___ - length--- -1--------------------------- X Seepage Pit: Distance to nearest well..___._"!-----------Distance fro f�oj ndation-_ ____-_.-Distance to nearest lot line.-%14 l<�j Number of pits-----f__..________Lining material__ _�.1.�.-Size: Diameter_ ___..___Depth__9r__i0. .................... Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material__._..__.._._...____.______.__.._____ G ❑ Size: Diarneter--------------------------------------Depth---------------------------------------------------Liquid Capacity..........-------------------gals. \ Privy: Distance from nearest well _______________________________________---------Distance from nearest building------------------------------------ ❑ Distance to nearest lot line-- -- ------ -------------------------------------------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe) ---------------`--- - - � ---- --------------------------------------------------------------------------•------------------------------------------------------------------------------------------------------------------• ------------------------------- t -----------------------------------------------------------------------------------------------------------------------------------------•-------------------------- ------------------------------------ -------- -- 1---------------- ----------- I 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 San Joaquin Local•Health District. (Signed) ----- ---=---- ------ ( 6or Contracto�J .s BY:---------------__............ -------------------f------------------ -- -- - ---------- - ------------ (Plot plan, showing size of lot, location of system .in ation to wells,•6uildings, etc., can 6e placed on reverse side). X € FOR DEPARTMENT USE ONLY // / APPLICATION ACCEPTED BY-------------- -- �°�- --------------------------------------------- ------ DATE----------�_f---�V - - REVIEWED BY------- -------------------------- --------- DATE-------------------•----- BUILDING PERMIT ISSUED------------- ---------------------------------------------------=----------------------------------- DA•TE---------------------- - Alterations and/or recommendations------------- --------------- ----- -----------------------------------------------------•------------------ ------------------------------------- i' ------------------------------------------------------------------------------- -----•------------------------------------------------------------------------------•--------------------------------------- I ---------------------------------- --------------------------------------------------------------------------------- ---------------- ---------------------------------------------------------------- ---------------------- - -------- ----- -------- ---- ---- - - - - ----------------------- ------ ----- = ------------- - ------------------------------------------------------ 1 FINAL INSPECTION BY------__._.`�.�---------------- Date------------- f ------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1661 E.Harelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street 1y Stockton,California Lodi,California Manteca,California Tracy,California F.P.C C.