20413 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: ---------- APPLICATION FOR SANITATION PERMIT Permit No. -------------- ----------- ------------------------------ (Complete in Duplicate) Date Issued ---------- This Permit Ez Ires 1 Year From Date Issued �,�/J�^ 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:. 49. 1od JOB ADDRESS AND LOCATI N - = _'"_ ------ ��t� -A -- -- ---------- `� ' Owner's Name--; Oz-� --°= — ----- C; Phone__46,� 202. -- --------- Address -`-r ; ----- ----- --- ------ Contractor's Name------- /tdCr�.c. - ct-ze-Q - -------------------------------- Phone..416332iQ9_------------ Installation will serve: Residence] Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __j___ Number of bedrooms __ ___ Number of baths ___I_ Lot size ____`�'�Qg---ZjO------------------------------- Water Supply: Public system ❑ Community system ❑ Private [7, Depth to Water TableW--- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel [] Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe M Hardpan ❑ Previous Application Made: (If yes,date---------------_---) No [Z New Construction: Yes :] No ❑ FHA/VA: Yes ❑ No k] 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_54---ftt}Distance from founclation__ _.Materia000A ret---b;d P4------_ (� No, of compartments.-. -- ------------Size_ ZIOU -.---- --•---Liquid deptl&-__ -------------CapacitsiQQ---$ 1_► Disposal Field: Distance from nearest well-5Q___fteDisfance from foundation__1Q-__ft__-Distance to nearest lot line5__ft,___.. Number of lines-----`a---------------------------Length of each line"1b---ft.-------------Width of trench_2___EX ft_.----------------- t Type of filter Depth of filter mate ral__a.9_AX0.htotal length- ------------- Seepage Pit: Distance to nearest well!QQ-_tt6--Distance from foundation_1Q_--- t*.Distance to nearest lot line_--- t_►-__ I Number of pits---P-----------------Lining material__TQck---------Size: Diameter-935---1U011,Depth_25_-ftr_w-------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-----------------------------------.-. � ❑ Size: Diameter------------- ------------------------Depth-----.-----------------------------------------------Liquid Capacity----------------------------gals. 1 Privy: Distance from nearest well---- Distance from nearest building ❑ Distance to nearest lot line--------------- - ------------ ---------------- ------------ ------------------------------------- -------- ......................- k Remodeling and/or repairing {describe):--------------------- ----------------•-•-------------------------- --------- -------------------------------------------I------------------ ----- ---•-------•-------------------------------------- ------------------------- ------ - -------------------------- --- ------------------------------------------------- - I , - - --------------------------------------------------------------------------------------------------------------------------------------- { I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinance$, State laws, and rules and regulations of the San Joaquin Local Health District. -------------------------- ------------------------------------------------------(Own (Signed)---�-�-_ -;Y�----�--------------- -------------- ------------------------------------ ._ -_ � er-and/or�Contract or(- �' ..-----------------------------------------------------------------(Title)---------- ---------------------------- ------ -- ------------- By:-------- - `"� (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY y� ' DATE �_=`�f_�l?.�'--------- APPLICATION ACCEPTED BY-- -- - -- -- -- -- ------ --- - REVIEWEDBY-------------------------------- -------------------------------------------- DATE--------------------------------------------------- BUILDINGPERMIT ISSUED-------------------------------------------------------------- .----- DATE----------------------------------- ---- - ---- ------------- Alterationsand/or recommendations------------- ----_------------------- ----------------------------------------------------------------- --------------------------------------•------------- f ------------- --- ---- ----------------------------------------------------- ------------------------------------------ --------------------- ------------ - ------------ -- ------------------ ------------- FINAL INSPECTION BY:.._ ---- -- Date ---1( II - j SAN JOAQUIN LOCAL. HEALTH DISTRICT 1601 E.Haxellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi, California Manteca,California Tracy,California F.P.CC.