19588 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: ,:. '-�- ---------------------------------------------- r-+ J --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No, /�a............ J-- f'a. ------------ --------------------------------------- ---- (Complete in Duplicate) p _______________________________ 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 �5/`�,,,,// � Q = j/ � ----------------------------------- IOwner's Name--------�1�- l._!lCh-e!fA/!� -------•------------------------------ ---- - Phone. D��a = - - ---- Address------------------ � __.. n s�� /11��'------------------------ Contractor's Name--------------------- 5�_ ---------------------------- --------- ---------- - ----11-------------------------------. Phone----------------------------------- Installation will serve: Residence ❑partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ..../-- Number of bedrooms ________� Number of baths ... Lot size ------,1____. _ -__._�-3---- mer-------------------- Water Supply: Public system ❑ Community system ❑ Private [EKDepth to Water Table _7Y ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam E] Clay Loam ElClay [IAdobe Hardpan ❑ Previous Application Made: (If yes)date----------------. -) No Construction: Yes P�- No ❑ FHA/VA: Yes ❑ - No TYPE OF INSTALLATION AND SPECIFICATIONS: ' (No septic tank or cesspool permitted if public sewer is available within 240 feet.) Septic ink: Distance from nearest well__.__._.__Distance from foundtion__.�Q________...Materiafl-�.._ e,el �/___________________ No. of compartmencs---.__ ------------Size----�XX_9.____Liquid[depth---_� -f�--...___Capacity__/� ( c / ! r Disposal -field: Distance from nearest well,_��---- from foundation-----/:6-_._-_Distance to nearest lot lite_____-�____ "V Number of lin es.---------r3___-----QQ- __-- - Length of each kne__4/11.-/0—-7/0--Width of trench--------3.._------------------- v Type of filter materia a__/CBC Depth of filter material----lt ---------------Total length________�2.41l,�____________________ ' Seepage Pit: Distance to nearest well----------------------Distance from foundation__ ------_-------Distance,to nearest lot line_______.________ ❑ Number of pits----------------------Lining material--------------.--------Size`Diameter-------------•---------Depth---------------------_----------- Cesspool: Distance from nearest well----------------- from foundation--------_----------- Lining material-._.____....__--__.___.-_-_________. ❑ Size: Diameter------------------------- --------Depth--------------------------------------;------------Liquid Capacity---------------------- ----gals. Privy: Distance from nearest well----__-------------------------------------------Distance from nearest building...._..._______-._______-_____..____... ❑ Distance to nearestaot line..- =----'------------------- ------ f�� ----- -•--- - !, Remodeling and/or repairing (describe):-- ------ ,f�_.G�!•�- -�f.-„e�/!�'+-'----•--•-----------=----------------•-•--•------•---• - ---•-------- I J-------------------------------------------------------------:------------------------------------------------------•------•---------------------------------- ------------------•--•------------------- -- . •------------------------------------------------ ------------------------------------------------------ I ------ ---------- - ----- ---------- -- � work will be d-----------'-�.:-'—=--------------------------- ------ --- ------ - ---- t y y p }p - e PP a -o ` ill --- 3 .. 1 hereby certify that I have prepared this application and that the. ane Ingaccordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local,Health District. r {Signed)------------------------------1------------ ------------------------------------------------------------------------------------- ------------------ ----(Owner and/or Contractor) __Title (Plot plan, showing size of lot, location of system in relation to wells, buildings,' etc.,Scan be plat;d on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY f -- --------------- `�' DATE- ----- ------r� -`-- -.5-------------------------- REVIEWED BY------------------ ---------------I--------- -------------•-------- DATE- ---------------- BUILDING PERMIT ISSUED-------------- =------ -------------------------- I---------------------- ---------------------- DATE---------------- --------------------------- Alterations and/or recommendations::-- -- ------- --- ----- -------------------------------------------------------------------------•-------------------------------- . --------------------------------------- - -- ----------------- ----------------•---------- - ------------------------------------------------------------•----------------------------------------------------- i i 1 ------ ----------------------------------------------- -------- ------------------------------------------------- -------------------------------------------------•-------------- ------------------------------- I ---------------------- - ---------------------------------------------- ------------------------------------- --------------------------------------------------------------------------------------- ----------------------------------------•-------------------------------------------------------------------- FINAL INSPECTION BY------ �� Date `_ ------- k SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. . 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California F.P.CO-