18564 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: ' "------------" APPLICATION FOR SANITATION PERMIT Permit No. _ ----- -------- -------- ------- ------- (Complete in Duplicate) Date Issued x ----------- -------------- - �� - This Permit Expires 1 Year From Date Issued Dist for a permit to tonstr c and install the work herein described. Application is hereby made to the San Joaquin Local Health This application is made in compliance with County Ordinance o. 549. D JOB ADDRESS AN OCATION. pho rle y ` ---------------- -! _;!" 1 / ------------ Owner's Name67� - --------- --------- Address. ( �- fes-.dT Contractors Name---- --------------- - --- -------p-------- -- - --- --------------- --- --- Phonet Commercia4 Trailer Court ❑ Motel ❑ Other ❑ Installation will serve: Residence � A artment House ❑ ❑ Number of living units: __j___. Number of bedrooms __- Number of baths ---- Lot size ____. - �' 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 F1 Clay Loam El Clay F) Adobe Hardpan ❑ No K FHA/VA: Yes ❑ No Previous Application Made: {if yes,date--.-----------------I No J< New Construction: Yes El TYPE OF INSTALLATION AND SPECIFICATIONS: I (No septic tank or cesspool permitted if public sewer is available within 200 feet.) L Septic Tank: Distance from nearest well________________Distance from foundation .________-._.____.Material_:.__.___________________ ____. ._____________. tt54(0f No. of compartments--------------------------Size---------------- d LiquideP.`h---------- ---------------Capacity----------------- ----- ❑ C ---"---Distance to nearest lot line---�-_------ Disposal Field: Distance from nearest well./[1flt[p.�Distance from foundation___.__- Width of trench-_-G -fr ------ -----_ Number of lines.__' - ��-------Length of each line___-Q.--�-1 41- Type of filter materlal_�__�_ �f1Gl�,,,Depth of filter material----- Total length______-"�--------------------- Distance --- ---------- -------- Seepage Pit: Distance to nearest well_.1.j� --Distance� ro`m�foundafiion___. ---- Distance to nearest 1 li .�__--__ Number of pits_ il _C� ---Lining materlal_JJ__Z_ �YO_GSize: Diameter__ Cesspool: Distance from nearest. well___,'_.___...._Distance from foundation ------------------ Lining material------------------------------------- Cesspool: ________ _________ _________ OO Size: Diameter-- .,' ,' :--------Depth ____---Liquid Capacity_ gals, . *0 .. a - -----------------Distance from nearest building---------------------------- ------- -.. VA Privy: Distance from nearest well------------------------------ ❑ ---------------------- -- -------------------------------------------- - Distance to nearest o+ line______---------- -- - ' s ----------Q------ ----------------------••-- - Remodeling and/or repairing (describe :------- - __ --------------------------- ---- °' € k ----------- - - -- - -- ---- - ------------------------ - - - ` _._-_____4-_____. _________ ____________________________________ _____ ._._ -- --------------------------------- x ------___. -- ------ AF ,, f -----------�- - -- - I I hereby certify tiiet"I'have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regul sof the S Joaquin L I Health District. t , -------- Owner and/or Contractor).rf ISi teed g -------- B ----- Title t - Y� ...... ---- �-!sem-- -- - ------ ----- --- --( ) (Plot plan, showing size of ot, location of system in relati n to wells, buildings, a#c., can be placed reverse side). FOR DEPARTMENT USE ONLY �_' 2-�i --------------------------- APPLICATION ACCEPTED BY----- - -- - - ------------ --------- --------------- -------------------------------------- ----------- DATE------�---------- ------ DATE----------------------------------------------------------- REVIEWED BY---------------------------------------------- ----------------- ------- -------------- --- ----- ----- - .. DATE-- ------...--------- ----- -------------------------------- BUILDING PERMIT ISSUED --------------------------------------------- ----- + and/oi e o trt ndations:--------------------.- --- _ ------ I ._ f --- ------------------- --------- ' -- . /` -, ---- ------------ ------------ -------- ------------------------------- __.�': _'_'_...__ �v =='�^_. s.__r-cgs--� ------------------- - ------------- -------------- --------------------------------- -------------------------- - - ---------------------------- -11-1 __Date FINAL INSPECTION BY:-------- .-_. ---`•--- - ti SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Naselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street t Lodi,California Manteca,California Tracy,California Stockton,California F,P.ca.