18221 - Laserfiche WebLink

Home Browse Search

rOR OFFICE USE: -------- -------`- -- ' � APPLICATION FOR SANITATION PERMIT Permit No. ...�._._l'l f ------- -- ------------------ ------------------------- (Complete in Duplicate) / Date Issued ------------- -------------------- 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 LO ATION....--- --------��-�--`�--------1�----{�-�-----�`-�-�.�'�'r'------'��!' -------------------- -----------------•- x -- ------ Phone------------------------------------ ------------ Address Name ' ` ( / f� l/11.-'"_"`-.:_ Address----------------------- "-�- - -----------------------• ------•-------------------------- Contractor's Name--------------- - �.- I Phone-- �- .�� - 1- // _ Installation will serve: Residence R Apartment Flouse [-] Commercial El Trailer Court [:1 Motel El Other El` Number of living units: -------- Number of bedrooms -------- Number of baths -------- Lot size ____________________________________________________________ Water Supply: Public system ❑ Community system ® Private ❑ Depth to Water Table 4p- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam 21 Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made-- [lf yes,-date-_---'-._--------) No V New Construction: Yes ❑ No Pq-._FHA/VA: Yes ❑ No,N i TYPE OF INSTALLATION AND SPECIFICATIONS: (No sepfic*ank or cesspool permitted if public sewer is available within 200 feet.) a Septic Tank: Distance from riearestM1'well_________--------Distance from foundation--------------------Matbrial__------- ------------------------------------ ` ❑ No. of compartments----- j------------------Size---------------------------------Liquid depth-------------------------Capacity----------------------- or Disposal Field L � Distance from' :iearest well._/e7P__.._Distance from foundation..o�tP_- _._.__Distance to nearest lot lin O____._.- [ Number of lines------- _ _________Length of,each line-------��_------------Width of trench-____�0_____..__-.-_.____ Type of filter material_._,5,�� Depth of filter material---,C ____--------Total length--- _____________________.____ Seepage Pit:`` Distance to nearest well____lcn ��.--Distance fr m foundation_ _______. Dista i9 to nearest lot line:-245--�--- Q�f 14�fi d �} Deptn /�- Number of pits -_-�.__._________Lining material-- ��__.S¢e: Diameter____ ___ ____ { Cesspool: Distance from nearest well--------------._-Distance from foundation.._________--_----Lining material----________________________________. k ❑ Size: Diameter--------------------------- ----------Depth------------ - --- ---------Liquid Capacity---------------------------gals. Distance from nearest building Privy: Distance from nearest.well--------------------------------------------------- 9----------------------------------------- n ------- --------❑ ---------- { Distanceto nearest lot line- - - ------- ----------------- '------- -------._---------- ---------------------- ------------------ -------------- Remodeling and/or repairing (describe):___ 1 -_ '' ---------------------------------- ----------------- �.:� •---------------------------------------------= -------------------- Y --------- --------- ---------------------------------•-------- -------------- --------- -------------------------------------- -- •------- ------ ------------ ---------- - I hereby:certify that I have prepared this application and that the work will be done in accordance with San Joaquin Counfl ordinances, State nd rules and regulations of the San Joaquin Local'Health District. rhe .---__-._,�•_----____#_---._- (O r and/or Contractor) (Signed) 1- /`" _ ------------------------- -------------------- ----- Title--------- - f---------------- ----- - ----- ---- I (Plot plan, showing size of lot, locaf system in relation to wells, buildings, etc., can be placed on Feverse side). � FOR DEPARTMENT USE ONLY APPLICATION ACCEPTC[5 BY__'_. 9'�_ ------------------ ------------------- /---`'— - ------------ ----- REVIEWEDBY-------------------------------------------------- ------71. -----------------------------------------. ----------------- DATE------------------------------------------------------------ BUILDING'PERMIT ISSUED------------------------------ --- f --i---1-- =---------\------------- DA•TE----------------------------------------- ------------------ Alterations and/or recommendations--------------- - a------------------------------------ -'---- --------- ---------------------------------.------------------------------ --------------------------------------- -- ---------------------------------------------------------------- ----• ------------------------------- ------------------- ------------ - ---------------------------- ----------- -----------------------=- -------------------- I , FINAL INSPECTION BY:---- C - .. Date f - 5AN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street I Stockton,California Lodi,California Manteca,California Tracy,California