22265 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: - s APPLICATION FOR SANITATION PERMIT Permit No. ........................ ---------------- -- ----- -------- ------ (Complete-in Duplicate) Date Issued _. 1_____________`� t ........................ ..._-- This Permit Expires 1 Year From Date Issued i 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 comp an with County Ordinance No. 549. • JOB ADDRESS D LOCAT N J�A/7I ?. �� F' s��c` at�:�- ------------------------------------ -4- &I -------------------------------•5 1 t t Owner's Name- -..E e��- . !r ��---f Ge"'IA... BtJ 11s G1It.E�'- Phone �'[ = � ' Address__---...�-�.-- F `'` ' � _ _ Contrac+or's ------ .------- -----------------------------------------_-- _ _ ----: _ - _. ..l--�_•�'-fit-� ----------------�--�-�---�---------... Phone.- --- -•• -�- •-- - J. Installation will serve: Residence ® artment ouse ❑ Commecial ❑ Trailer SCourt ❑ Motel ❑ Other ❑ ' Number of living units: ---- Number of bedrooms _ Number of baths/---- Lot size Water Supply: Public system ❑ Community system ❑ Private U�- ?1'epth to Water Table ------ _ ft t Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,dote_.__------- __--- } ''No-[] _New-Construction: Yes -No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if pu is sewer is available within 200 feet.) Septic Tank: Distance from nearest ---_--Distance frorq fot_ion_ 1_0_"_ _'_..Material .. 7- No. of compartments- _Z � __ Liquid depth__.____. _ _Capacity___ Z � Disposal Field: Distance from nearest well- Q-- --Distance fForri foundation_1__Q...._.......Distance to nearest lot line-----sati ...... ' F // Type of filter mated _..___'__Depth hofffilter{mrater�a�_:� �f W'dth of trench...,�.�__ .-________.__._ � Number of lines__. g .- Total length-------------- Seepage Pit: Distance,#o near t well.. _t ___-=- Distance from foundation___=_�_ =___.i?istance to nearest Io} line__.____.__ . U Number of pits.._____________Lining materia1.RPcic------ Sizer Diameter__ `�..__..Depth____-G.6_`______--_ ' Cesspool: Distance from nearest well4`1)______D,istance from"foundation-....-.._...__._ ..Lining material_____________________________ ______ Size: Diameter- - ------- ----- - -` - - .....Dept h-.-- ------'"--------------`---- -- ----------.:Liquid Ca acit als. Priv Distance from. nearest wel}____...._.-'_ - ------ --_-_- . .Distanice from nearest b0clin ---------------- --__ El Distance to nearest lot line --------------------------------------------------------`----------------------- --------------------------- Remodeling and/or repairing (describe)---------- ---"-- ---- ------ -----------------------------------------------------------------"------•---•-------------------------------- K r [ i _________________________________________ I hereby certify that I have prepared this application and that the work will'be done in accordance with Sart Joaquin.County ordinances, Sate la and rules and regulations of t San oaquin Local He istrict. t f 5i ned�� - f tI - - ------ ----- Contractor) 9 ) F [ J # ( ) i BY:------------------------------------------------- ------ ------- -- ------- ----- --------------(Title)---------------- ------------------------- _---- (Plot plan, showing size of lot, location of system invrelation wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY I ------- APPLICATION ACCEPTED BY____-__._-_.'. . - -- - ------------ -------------- DATE------ -'- REVIEWED BY------------------------- 'x -------- ----- DATE---- - ---- BUILDING PERMIT ISSUED-------- - -------------------- ----------------------------- ---- . . --- -- DATE. - Alterations and/or recommenda ions:......-._ -,P'._-t�r.7_.._..rf `�. ___�� _ e.. ®._____t Y � -••-------------- - Q • ----------------------------------- ------------------------------ -------------------- .. -----•-- -- ---- ------------ ------------------------------------------- . FINAL INSPECTION BY:...... ------------ Date.......... ..---------- . i r SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Maielton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi. California Manteca,California Tracy,California E.H.9 2M 1-67 Vanguard Press