19529 - Laserfiche WebLink

Home Browse Search

FO OFFICE USE: --.- . ' - 3 ----------- 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 cnstruct and install the work herein described. This application is made in compliance with County Ordinance No. 549. - JOB ADDRESS AND LOCATION _ --------- 3------------------ 2. v �c -----------------C Owner's Name------17_-.� �.:-- - ----------------------------------------------- ----- ----------- Phone.--------------- l Address----...A0_-lg--- -c..-... _ ------------------------------------------------------------------------ Contractor's Name--------- `7__T ------------------------------ -----. Phone----------------------------------- Installation will serve: Residence ®r-_�Xpartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other _ Number of living units: --, _-_ Number of bedrooms ---9- Number of baths I------ Lot size ❑ {� s fada!�o-n----------•--------------------- -- Water Supply: public system ommunity system El Private El Depth to Water Table-p/ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe E —Hardpan ❑ _j Previous Application Made: (If yes,date--------------------) No EA�New Construcfion: Yes-F�No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Ta k: Distance from nearest well-- --------------Distance from foundation_rP_---...........Material --- --_------- No. of compartments......� -- -----Size---- X-9 ---Liquid depth-------- ------Capacity---i'oe Disposal Field: Distance from nearest well__--.-.--_-_Distance from foundation---ld_............Distance to nearest lot line-__,,1_ __-._ Ln [� Number oflines_-----r---------------------------Length of each line_--70--'_----------------Width of trench__9_�_`�__-__�-_--_----- N Type of filter maferiar)J?oc,/&_----Depth of filter material--__-lg-''__-__---Total length_-_---9¢ -------------------------- Seepage Pit: Distance to nearest well..-- -`Distance from foundation----/0_P----_-..Distance to nearest lot line_,-Y_J______ [ Number of pits__-'/----------------Lining material-jp[A--------Size: Diameter------.3- ----- Depth----1?15-_'-------_-------- Cesspool: Distance from nearest well-----------------Distance from foundation._-__,--------------Lining material----------------- ----._ El Sze: Diameter-----I------------ -------- ---------Depth--------------------------------------------------.-Liquid Capacity------ ------------------..gals. Privy: Distance from nearest well-----------------------------------------------...Distance from nearest building- ❑ Distance to nearest lot line - - - ( --------------------------------------------- i Remodelingand/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, State laws, nd rules and reg iat' ns of the San Joaquin Local Health District. (Signed)-------------- - `��- ' -----------(Owner and/or Contractor) By: ---------- ------------------- --------------------------------------------------------- ---- Title __ (Plot plan, showing size of lot, location of system in relation fo wells, buildings, etc., can be placed on reverse side). t + ( FOR DEPARTMENT USE ONLY u APPLICATION ACCEPTED BY--------- = - ------ DATE' EVIEWED BY --- -.. ----------------------------- TDATE------. BUILDING PERMIT ISSUED-------------------------------------------- DATE 4-Alterations and/or recommendations: __..._ ------------------------------------------------------------ -------------------------------------- ---------------------- -------------------------- ------------------------------------------------------ ---------- '---------------- ----------------------------------------------------- ---- ----------'-------------------------- t- FINAL INSPECTIONi BY: ___- .- `/ l- - ------------- - --- -- ------- - Date------ -------------- ---------- -------- �-----�- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. i 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California