18463 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: — =�G-� -- -------------- ------------------------------------------ ! -_ APPLICATION FOR •SANITATION PERMIT Permit No. `f 3 ---------- ----------------------------------------V (Complete in Duplicate) / --- ---------------- -------------- ----------- ----- This Permit Expires 1 Year From Date Issued Date Issued ._a�14-•% 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 L CATION_- Y_�'�, } ---------------------•----• ---• --- ---Owner'sName_ __-__ - -------------------------------------- Phone--------------- -------------------- Address- ------ - -•-- Contractor's Name---,_-•- ._-_-__ Phone----------------------------------• Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Mate! ❑ Other ❑ Number of living units: --�__ Number of bedrooms __ Number of baths _---_--- Lot size _ � - -_ Water Supply: Public system Community system F] Private ❑ t�Depth to Water Table tt Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe P--gardpan ❑ Previous Application Made: (If yes,date--------------------) No New Construction: Yes ❑ No RP'MA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic.4-ank:� Distance from nearest well----------------- from foundation_________----------Material---------- ------------------------------------ No. of compartments- ------------------------Size--------------------------------Liquid depth-- ------------- CapacifiY Jr, Disposalji Id: Distance from nearest well ... __-_Distance from foundation.-/-Q-_f--- Distance to nearest lo{ /fr Number of lines________ _• ----------Length of each line-_- -' J---- g �-s�---- fi-----Width of trent}�__.r�-- ----------------------- Type of filter material./�A Depth of filter material--.- - -Total length-------- ---________--_- Seepage Pit: Distance to nearest well------vim ----Distance fro � to nearest lot Number of pits-----,l-----_-------Lining material_- / Di .Size: ame#er__,. _. . � --- Depfin-a?45 Cesspool: Distance from nearest well-----------------Distance from foundation---------------.... Lining material _.;.__-__.___.____________________. ❑ Size: Diameter--------------------- ------------- Depth-------------------------- -------------- - ----Liquid CapacitY----------------------------gals. Privy: Distance from nearest well____ ________________________________Distance from nearesf'bdi€din g_ ----------------------------- ❑ Distance to nearest lot line___________ ---- ---•---------- Remodeling and/or repairing (describe)- ----------------��LiG L`'�� V - ------- - --- ------------------------------------------------------- �. I ---- --------- ----------------------------------------------------- ----------------------------------------------------- = --------- -------------------------- = - -------------------------------------------------------- _.---------------- I herebycertify that I have b y prepared this application and that the work will be done in accordance with San Joaquin County ;• ordinances, State laws, and rul and regulations of the San Joaquin Local Health District. (Signed)_ -- -------- - ------ I w Contractor) t ) By:----------------------------------------------------- -------- ------- of plan, showing size of lot, location of system in rel n to wells, buildings, etc., can be placed-:oreverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_._.___._- - '1. .� --- -------- D`ATE------- 1_:--. ----------------------------- REVIEWED BY. ------ . ;---"`----------------- -r- --- DATE------------------- __ ---------------------------------- --e ------------------------ UILDING PERMIT ISSUED Z- --------------------------------------------•----�-.---- - ='--�-- DATE---- - ----------- -------------- -------------------- AI{era{ions and/or recommendations -------------- ----- ---------- ---- -_--_- ' ---- --------------- -- ------- --- _d)_ FINAL INSPECTION BY:-------- - e ------- Date---------�`- = �-i=`� � SAN.JOAQUIN _LOCAL HEALTH DISTRICT� --- 1601 —1601 E.Npzellon Ave, l+ *N 300 West Oa k Street Stockton,California Lodi,Coi! j thx t24'Sycamore Street 205 West 9th Street ifornia Manteca,California Tracy,California F,P.C O.