19390 - Laserfiche WebLink

Home Browse Search

F R OFFICE USE: r rte. ------------------ �`' .. .. tea:o a APPLICATION FOR SANITATION PERMIT Permit No. ------------------ ---------------------- --------- --- (Complete in Duplicate) Date issued -------__ "__. This Permit Expires 1 Year From Date Issued . ..�__. Application is hereby made fo 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. i� ` .� l -. ----------••-----------------------•---- JOB ADDRESS AND LOCATION ____ �LI---�_--�-----'------------p- - -- --- Owner's Name------------------- -�/--- -----------V0 15.10 Phone Address ....r.........�in— � +!-_ �. .r __... lv Contractors Name--------------- ------��/�_�----------- ------------•-------- Phone__��f - Installation will serve: Residence Ur"'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___L Number of bedrooms -__Number of baths _-e�__ Lot size ____.--T -------------------- li Water Supply: Public system EeCommunity system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depWof 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [flay ❑ Adobe ❑ Hardpan ❑ r Previous Application Made:l�llf yes,date--.--------.--------I No Q New Construction: Yes ❑ No []t` FHA/VA: Yes ❑ No �— i TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted,if„public sewerYis4availab-I ,i4hin 200 feet.) Septic Tank: Distance! from nearest well-_--____..___---Distance from foundation--------------_____Material---------------------.._____.____---------____. ❑ No. of compartments--------------------------Size---------------------------------Liquid depth--------------------------Capacity----------------------- Disposal Field: Distance from nearest well __._+------._Distance from - founciation__��..-.Distance to nearest lot Number;,of lines------1 ---------- Length:of each line__ __ ---------------Width of line_ ---------- Type ofifer V,<-Depthmaterial7of filter material---�7"____--Total length_______' _ --------------------- I __.- - - G 11 Seepage Pit: Distance, to nearest well-._.___—'__-----Distance fi m.foundation_ ---------Distance to nearest lot line Y--.. Number?!of its__ p _.__..._.-__Lining material___ -Size: Diam`eter_____$ _��__,Dept h------ A.<-_'_____________ Rr :. Cesspool: Distance from nearest well_________________Distance from foundaiion___L __..._..Lining material-._.----...---------.--.___.______._- Size: Diameter-------- ------------------ ----------Depth---------------------------------------------- Privy- ----------------- -- --------------------- Liquid Capacity gals. i Privy: Distance from nearest well...............____.____-__--___.__-____..__..Distance from nearesf building-------__-._____.___----------_______----. I ❑ _. Distance to nearest lot line. ------ --------- ---------------------------------•-•----------------------------------- -------------------- -------- Remodeling and/or repairing (describe:--------- -------- l / -- - t -- ---------------- ----------•-----------•--•--------------- :---•--------------------------------------------------------------------------------------------------------- IIf 1-�------------ ---------------------------------------------------- ------------------------------------------•----------------------------•------•--•------------------------------•--------------------------•-- %.* I hereby certify that I have prepared this onp of the Sant oaaui hLoca{Hea�l#IieDis --- ----------------------- - ------ -- - = ------------------•----------- I one in accordance with San Joaquin County F ordinances, State�Iaw ;.rules and regula s q y trict. C�, O r dor Contractor(Signed) lT.--------- � --"--------------------- ( l )------------ - --- V By:---------------- --------------- --------------------------------------(Title)----- #-- --------- (Plot plan, showing ' e of lot, location system in relation to wells, buildings, etc., can be placed on reverse side). ' FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED. SY____ ��---- --------- - ---`--------�---- ----------------------------- DATE------ --�--ld .._.�5------------- - REVIEWEDBY------------------------------------------- - ----- --------------------------- ---------------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED------------------------------------------------------'----------------------------------------------- DATE----------------------------------------------------------- Alter tions and or_reco -------------------------- en at' ns_____ _________ - " - ----------------------------- ----------------------------••---------- ---------- f• w ".,o ;I FINAL INSPECTION BY------------- �� '`. ....Q -t- Date- � r`- S N JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hasellon Ave., 300 West Oak Street 124 Sycamore Street 205 West 9th Street { Stockton,California Lodi,California Manteca,California Tracy,California F r.P.C C.