22201 - Laserfiche WebLink

Home Browse Search

ll FOR OFFICE USE: i ------- ----- ----- - --- Permit No. C�..�-2-------•-�F ,. APPLICATION FOR SANITATION PERMIT - - - ------- ------ ------- •--- �i i �'-- ------ --- ------------------------------ (Complete in Duplicate) --- Date Issued EI .•:.-- ------------ This Permit Expires l Year From Date Issue lApplication is hereby made to the San Joaquin Local Health District for a permit to construct and install the wo rein d�ri ed. 6 This application li tion is made in compliance with County Ordinance No. 549, r JOB ADDRESS A LOCATION..,;?00- ` 60wners Name- £ " E! - - - - ---- '------ •------� - - ------- ---- ------------------------------------- Phone------------------------------------ .-.___ _ I Address------------ ---------------•-------- �iContractor's Name r - � ' --------' --------- Phone l;Installation will serve: Residence E] Apartment House E] Commercial E] Trailer Court ❑�Motel El Other El�� I Number of living units: _ __ Number of bedrooms_--- Number of baths .�_ Lot size __ -•�---- j Water Supply: Public system ❑ Community system ❑ Privateepth to Water Table 6,0�1t. t t I�Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan [' Previous Application Made: (If yes,date--------------------f No [��New Construction Yes L"_'� "'c ❑� FHA/VA: Yes 94—NO C V. TYPE OF INSTALLATION AND SPECIFICATIONS: I ' I _(No septic tank or cesspool permitted if public sewer is available within 200 feet.) .�..; � Mat ria ----------- Septic Tank: Distance from nearest well_----Disfance f om foundation_-, ___.______... ! - ,� r[ � No. of compartm `Sizers- •3.Liqu�d de�t�� .__- Capacity/.2, _V---- No. Field: Distance from neares well. .-_Distance from foundati j Distance to nearest t line_.__ � / Number of lines__--- of each line___ __ ._ Width of trench______._�___________________ j1 Type of filter materi �0_,�,_Lengfh p _.Depth of filter material___�tJ_ .__:,-,__Total i length_ _______________________ Seepage Pit: Distance to nearest well--------------_______Distance from foundation-----------------__.Distance to nearest lot line----- ----------- ❑ Number of pits Lining material------ ----------------Size: Diameter-------------- --------Depth------------------------------------------- E Cesspool: Distance from nearest weld-----------------Distance from foundation------------------- Lining material----------------------____._____..__ �� ❑ Size: Diameter----- --------------------------------Depth-------------------------- ------------------ --c---Liquid Capacity----------------------------gals, Privy: Distance from nearest well---------------------------------------------. --Distance from nearest building--------------------------------------- -------- I ❑ Distance to nearest lot line--------- --------------------------' ------ ----- E - f .� .� ------------------------------ - Remodeling and/or repairing (describe):--------- = •----- -------- - -------------------- -------------- - ----- ------------------ t '1 + __ ---------- -------- ------------- --------------------------------------- ------------------------------------------------------- --------- - -- i l hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and r les and regulations of the San Joaquin Local Health District. a I �/ " wan Contra r] (Signed) ----- / (-_ `' ---- ---------- -------------- _._ ;(Plot plan, showing size of lat, Tocation of s stem i ation to wells, buildings;etc;can a placed o" reverse side}. FOR DEPARTMENT USE ONLY fJ APPLICATION ACCEPTED BY------------ ---- ---C7- - �'^�('� P ---- - ------------------- DATE. - /' / ---------------- IREVIEWED BY-------------------------- ----------------- - ----------- --------------------- ---- -------------------- ----------------- DATE-------- - -'---------------------------- ----------------- EBUILDING PERMIT ISSUED------------------------------------------------------------------------------------ ---------------- DATE---------------------------------------------------------- I L i '-Alterations and/or recommendations:-------------- --- --------- -------------------------------------------------------------------------------------- ---- _-------- - ----------------- . ------------------------ -------------------------------------• --------------- --------------- ----- -- -- ------ -------------- i ------------- ---------------------- ------------------- -------------------------- 3. ----------- -------- ---------------- ---------------------- ----------------- - --- ----- ------------------ a. FINAL INSPECTION BY: % Date. `f ---------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Maiialtan Ave. 300 West Oak Street ' 124 Sycamore Street 205 West 9th Street 5tackfan,California -. Lodi, California Manteca,California Tracv,California F.P.C C.