18306 - Laserfiche WebLink

Home Browse Search

�_. - '---------------- ------- ------------------------- APPLICATION FOR SANITATION PERMIT Permit No. -- ------------------- ------- ------------- --- -- - ------- - - -- - - - (Complete in Duplicate) TFlis Permit Ex fres I Year From Date Issued Date Issued .______ 5� y Application is hereby made to the San Joaquin Local Health Distri /14 i . This application is made in compliance ith ount ct for a permit to construct and sial aSo -rk h 2o� E . _YK/�enJ Ordlna 1141 JL No. 54 ! the v oil; he in described. ,,J B ADDRESS AND L CATIA N._ / OP Owner's Name . ,�{'()P�� g -- 111 ,,Address-------------------- "'--------"" Phone rr 11 _ . Contractors Name------ " -•-----•- Installation will serve: Residence ------------------"--------- Phone.._.__. -- ______ __ f Apartment House ❑ Commercial - ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _____ N ber of bedrooms __'._Number of baths _f----- Lot size Water Supply: Public system - Communit system I Y Y ❑ Private ❑ Depth to Water Table _;LC_ {t• Character of soil to a depth of,3 feet: Sand Gravel ❑ Sand Loam Previous Application Made: (if yes,date--------- ❑ -- --- } NoY �, �� C1ay Loam,❑.Clay❑ Adobe[_]..—Hardpan-E] TYPE OF INSTALLATION_AND SPECIFICATIONS: New Construction: Yes [ ElFHA/VA: Yes ❑ No T(No septic tank or cesspool permitted if public seweris available within 280 feet. 'eptic�nk: Distance from nearest well----- A_f Distance from foundation"---- Material ' No. of compartments Mafersai__-___ I � p Size---' -A-��-X(.'; --- - ,�_ Dis osaJrFieid: , f Liquid depth---_"-- . ..........Capacity_-""_. _4'_«-- p s Distance from nearest well- � -_ _Distance from foundation_-___. --Distance to nearest lot line_S� -------- Type -"_"" =fi „ rp Number of lines________________ -.----------Length of each line------ ("Q _��+ Type of filter material_ _ . L 1 Width of-trench..__C�... fr -,► -Depth of filter material---_ / - Seepage Pit: Distance to nearest well------------------- Total length__.". _AO ' r . r . Distance from foundation--------------------Distance to nearest lot line----------------- � ❑ Number of Pits._.__- Lining material"__-__- --------------Size: Diamefer-----------------------Depth--------- -------------------- Cesspool: Distance from nearest well______________--Distance from foundation__.___.--"-- ' ❑ Size: Diameter----------------- ------.Lining material--------------------------------- Privy: -----------__ s Depth------- ------ ------- --------------- ---------------------------............... Capacity-------------- nvY Disfiance from nearest well____--_------_-_ - gals. _________Distance from nearest building ;:"❑ Distance to nearest lot line--=------------'----� -- ------"----------------__--- --------------------- Remodeling and/or repairing (describe):------- I y Y _ x ----------- ------� "�-------- ------ ------------------------------------------ --------------------- } ------------ ..__.. - ! 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 regulations of the San Joaquin Local Health Dist rict. -� (Signed)------ - �`�C- �-� ------------ --------- ------ --------------------------- --------------- ------------------------ BY=-------- " (Own and/or Contractor) t (Owner d/o Title__ _ (Plot plan, showing size of lot, locfio of system in relatiowells buildings, ( ) �w etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY REVIEWED BY-- � -[--f-"--1---�- ----------- --------------------�--►l---�-r-'-�-------_-_- -- _ DATE ---- -�- ------ �- - _ _-._.-_ ,_ �------- -- -•------ ✓ -- -----Irl - �� BUILDING PERMIT 1SSIED- -C1Q ^------ DATE.----- -------------------------------_-- . Alterations an or recommendat , � ,, ------ DATE------ --------------- I - "-_"_ -_QR11t----------------------------------------------------------- CA V? �a r�-�q�Af/-'� �-- •--------------------------------- V- f----------- -- FINAL INSPECTION BY:. Date _- ��}-R- '�la.-` ---- ------------------- �i� SAN JOAQUII�NLOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. CU�00�sf�Stre. A 724 Sycamore Street Stockton,California Lodi,California 203 West 9th Street �} Manteca,California Tracy,California