18829 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: t _ ---------------------- --------- 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 construct and install the work ,herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION----/_70------ .SS .I. Owner's Name l-t ---------/ _1f.�2 1 '.. ........I.,- -- ------------------------------ -- Phone---- - Address .7- ......Ca71_'S -r 1. 1_ .. -•---------------------- --•------ Contractor's Name �PiQ S I-- /1 -------------------------------•-------------------------------- Phone_'¢1.46._0 _®---- Installation will serve: Residence 2],-Apartment House ❑ Commercial ❑ Trailer: Court ❑ Motel ❑ Other ❑ Number of living units: ,_ __ Number of bedrooms _3_-- Number of baths __/__ Lot size ---------7• kr ',/-.7_5-------------------- Wafer Supply: Public system �E9--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: (I'f yes,date--------------------) No ❑ New Construction: Yes ❑ 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 Tank: Distance f tom nearest well________________Distance from foundation-----------------_-.Material____-_-______.---- ----------------------------- ❑ No. of compartments---------------- Size --------------Liquid depth----------.---.----- -----Capacity----------------------- II r Disposal Field: Distance fnom nearest well_________________Distance from foundation--------------------Distance to nearest lot line________________ ❑ Number ofd.lines-----------------------------------Length of each line--------_--------------------.Width offrench-------------:--------------------- Type of filter material-__-____-..__-_____----_Depth of filter material----------------------- length---_________________________________.__- 1 �I „�' i Seepage Pit: Distance to nearest well_____________________Distance frgm foundation_____7.�___.Distance to nearest lot line_.____________.._ Number of;pits --------------Lining material__ �_��_��' Size: Diameter__v ......_.._._.Depth----.-----___..____-- N Cesspool: Distance from nearest well------ ----------Distance from foundation--------------.----.Lining material____.____________-__________________ _ n ❑ Size: Diam�e�.fer-------------- ------- ----------------Depth----------------------------- ----- - - --- --Liquid Capacity - - ----gals. V Privy: Distance from nearest well_. ------------------------------------Distance from nearest building------------------------------------------- ❑ Distance to nearest lot line---------- - -------- - ----------------------------------- Remodeling and/or repairing ((describe):-_ _ � rll --_ • �' �I $ "! �--------------- --------------------------------------------------------.----------------------------------------------------------------------------- ----------------------------------------------------------------------------------------- ---------------------------------------------------I-------------------------------------------------------------------------------- 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 iM d regulations of the San Joaquin Local Health District. (Signed) !M � --------------------------------------- ---------- n and/or Contractor) BY --- -----=----- ----------=^_.-_:----------------------(Title)---- f---------- - - - - --- -------- (Plo# plan, showing size of ot, location of sys em in relation to wells, buildings, etc., can be placed an reverse side. FOR DEPARTMENT USE ONLY r��'r" APPLICATION ACCEPTED BY r'�� — DATE _ env_ .� = REVIEWEDBY --------------------------------- ------------------------------------------------------- • DATE------.-,----------- --•------------------- ---------------- BUILDING PERMIT ISSUED-_1 - -------------------------------------- ------ Alterations an or recommendations:.________ __ _ � ,_ ._____.__T� —�__ -` ✓� tC'------------------------------------------------- -- ------------------------------ ------------- ------- ------ -- - FINAL INSPECTION BY:------ .--� -'. .-------- - Date----------------------- / --------------------------- SAN ----- ----------------- SAN - --- JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haseltan Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca, California Tracy, California s F.P.E`❑. I {