21879 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: j -------------------=---------------------- ..-------1-. APPLICATION FOR SANITATION PERMIT Permit No. ... ..:................ --- -- -- II (Complete in Duplicate) _ 7 _.. -- - ---- - ---- ----'��__ This Permit Expires 1 Year From Date Issued Date Issued _____.______--____ Application is hereby made.to the San Joaquin Local Health Dis rict for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance o. 549. LL II I e JOB ADDRESS AND LOCATION--- �------- --- ----- --- ------- ----- - p-- ---- - ------- --- - -- ------ --- ------------------p- ----- --f-- .OwneF's Name------ CC ------- ------ -- ---------------- Ph e Address------------ - ----- --------- ---- ------------------------------------------------------------------------------------------------------ ---•------- Contractor's Name-----------------i------------------------- ---/4- _1JS_ ---- ----S OMS----------------------------- Phone_�f ------ Installation will serve: Residence)< Apartment House E:1 Commercial L] Trailer Court ❑ Motel ❑ Other ❑ Number of livingunits.'_1 1--_'Number of baths _ ______ Lot size __ Q x__.I_. -�___________________ � �-____ Number of bedrooms _�� Water Supply: Public system ®Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date........___ _______) No Dk New Construction: Yes E] No X PHA/VA: Yes ElNo K I TYPE OF INSTALLATION AND SPECIFICATIONS: V (No septic tank or cesspool permitted if public sewer is available within 200 feet.) /� fromDistance nearest well------------ ---Distance from found _ ation_.___________.___-_Material__________-.______.___._____________ -----__-__. Septic Tank: C No. of co partments--------------------------Size--------------------------------Liquid depth---------------- ---------Capacity----------------------- Disposal Field: Distance from nearest well-/.G19LR-__Distance from foundation__ W_-__.-_-Distance to nearest lot line___.Si�� KNumber of lines__ _____ _ _�_-_ _.___Length of each line__--- --.Width of trench-_; y� ._____:_ Type of filter material.__ __ _Depth of filter material____-___1- -------Total length________.��________ --- ------------ Seepage Pit: Distance to nearest well__A)0,V�__--Distance om f ndation___! -------Distance to nearest loot line__.�� -_ T Number of pits_____Lining material- ___ °��_.5ize: Diameter. --------Depth__.p(,_ _�_______________ Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining material-----------------._-_______________- ❑ Size: Diameter--------------------------------------Depth------- --------- ---------- ------ - -------------Liquid Capacity-------------------------gals. Privy: Distance from nearest well---------------------------------- -------___-__Distance from nearest building-------------- ----------------------- ❑ Distance to nearest lot line---------------------------------------------------------------------------------------------------------------------------------------------- Remodeling and/or repairingl,l(describe):---------------------------------------- ------------------------------------------------------ -------------------------------------------------------- --•--•------------------ ------•------------------,i--------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------- == --------------------------------•------------------------------•----------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ I hereby certify that I have re ared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and es an re ulations of the San Joaquin Local Health District. g (Signed) ' -k - 0'- ------ ------------ --- ------(Owner and/or Contractor) By:------------ --�1�o �of - -----------------(Title)----- - --- se -- - ------- (Plot plan,showin m in relaton to wells, buildings, etc., can be pla on reverse side]. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------- -------- -- - - ------ -------------- ---------------------------------------- DATE----------414-A-01 --------------------- REVIEWEDBY-------------------------`-------------- --- ------ DATE-------- -------------------------------------------------- BUILDING PERMIT ISSUED--'------------------------------------------------------------------------------------------------- DATE-------------------------------- -------------------------- # Alterations and/or recommendations:-------------- --------------------- - ----------•------ --------------------------------------------------------------------------------------- I -------------------------------•----------- - ---------- ----- II li I __________________________________________________'__._e_.________.______..._.__.-.______-._.-._--------------------- ---------------------------- ----------------I------------------ ------ -------------------------- - -- -------- -______.__.-.______.___-______________________________________ ________ _I_.---------------------- p FINAL INSPECTION BY:..1IC :-------d441,111-----___.________-- Date �I SAN JOAQUIN LOCAL HEALTH DISTRICT k 1601 E.Harellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street i Stockton,California I� Lodi,California Manteca,California Tracy,California E �I II �