19913 - Laserfiche WebLink

Home Browse Search

1-UK Url-K–L UJt: 6.f'-------------------j ,,00/.�M ___________---- --------------- _-___-___-_... APPLICATION FOR SANITATION PERMIT Permit No. ��(��- .__ ------ ----------------------------------------------- (Complete in Duplicate) Date Issued la-_ sJ ------.---------------------------........_____.__;..__ This Permit Expires 1 Year from 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 ._ --- `-'`� ,rl-Sf"14 •S � /, ------------------------- Owner's-Name _ /Y �a Phone Address....................• ? ---------------------------------- Contractor's Name------ <- Y._f-----If�f( /--fl�---G 1�/[� f----, ./Y_ �---------------------- Phone-1WP'` 2.;_-7---•- Installation will serve: Residence ©-Apartment House ❑ Comm11 ercial ❑ Trailer Court ❑ Motel ❑ Other ❑ g >` --�--- Lot size --- ------------------------ r/Dl -- I Number of living units: _ __._._ Number of bedrooms __..__�_ Number of ba Water Supply: Public system � `ommunity system ❑ Private ❑ Depth to Water Table _-_-.-.- ft. t Character of soil to a depth of 3 feef:x-Sand-❑-;Gravel ❑ Sandy Loam ❑ Clay Loam Q- Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date---------------------) No ❑;i— New Construction: Yes ❑ No [3- PHA/VAI Yes ❑ No ®--- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well .............Distance from foundation-------------------Material---------_-.-...----_-___-_____.______-..._--_--. ❑ No. of compartments-------:--R--------------Size--------------------------------Liquid depth-------------------------'Capacity--------- ------------ � s. Disposal Field: Distance from nearest well.............__-Distance from foundation--------------------Distance to nearest lot line.-_.----_.-.----- ❑ Number of lines---- s_=---"------------ ------Length of each line------------------------------Width of trench-._-------------------------------- Type of filter material------t------------------Depth of filter material----.------------------Total length_1-----------------._._----------.-----._ Seepage Pit: Distance to nearest well--------.Distance,,fr��'' foundation-_`-_____..Distance to nearest lot line----------------- � 0 Number of pits---- l______________Liming material-_-lY�fxl-_.Size: Diameter__- ? ...------_Depth----- x` _-------- Cesspool: Distance from nearest well-------- .!_ __Distance fromffoundatio L'ini ma'erial--------------------_---------------- % ❑ Size: €diameter----------------=-----•--------� ----Depth '�`a� } Liquid Cap acit -----------gals. Privy: Distance from nearest well___-_.__. _._.______________________________Distar, efrom nearest building-- -----_--__--__--____ ---------------- Distance to nearest lot lire------- I_,_ # --------- ------------- ------------ ------------- Remodelin and/or re airin dscribe .-_---. - � ------------- --------------- ---•--------------•-------------------------------------------------- F--- -------•------------------------------------------2! - ------------------- I_r*------------------------------------ `` -------------------------------------------------'------'---------------------------------A-------------------------------------- } -------------=----------------------- -------------------------------------------------- f --------------------------------------------- ---------------------------------•--�=--- '-------------------------------- I hereby certify that I have,prepared this application and that the work will be done in accordance wifhl an Joaquin County ordinances, State laws, and rules and regulations of floe San Joaquin Local Ilfealfh District. {Signed) ?.' , - / — _. (Ow 4r and/or Contractor) � '�� BY �----------- �`�- - --- -- -------- --------------------------------------------(Title)-- --- ,------------ ,--- ----------------- (Plot plan, showing size of lot, IoY ion of system in relation to wells, buildings, etc., can be placed on revese side}. f FOR DEPARTMENT USE ONLY i APPLICATION ACCEPTED BY_- 7N4 ------------------------------------------------- DATE ---g ------------------ REVIEWEDBY-------------------------------I----------------------------------------------------------------------------------------------- DATE------------------ BUILDINGPERMIT ISSUED--------I--------------------------------------- ----------------------------------------------------- DATE--------------------I------- ----------------------------- Alterations and/or recommendations:-- - .------- --� - -- - --- ----------- -�—""..`".r,w°:'.-""'."."."-------=-----�-------------------------------------- ---------------------------------------------------------------------------- '* = == -------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- FINAL INSPECTION BY:_".. Date-------------- -- -------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hoxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO.