17996 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: r ,,, 2�11>/6-s ----- ---------- ------- APPLICATION FOR SANITATION PERMIT hermit No. .--/_?9lr.A... .r ------ ------------------------------------------------ (Complete in Duplicate) ---------------- ---- This Permit Ex ires 1 Year From Date Issued 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 compliance with County Ordinan�,No. 5499. JOB ADDRESS AND LOCATION.4-��--0-- -4-' ......... --------------------------•--- BP'S'-----------�- Owner's Name `' I -- 1^• �'1------ - __ � f � / -•�, ---------- Phone_ - Addressl�[3 --...- `�`_'' T ° Q`"` �- ----------------------------•--------•_-------- Contractor's Name---------•------------------------------------------------------- ------ Phone-------•------------------ Installation will serve: Residence). Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __L____ Number of bedrooms __ ____ Number of baths __j-____ Lot size ----7x 7s--------------------------- ----- Water Supply: Public system.N Community system F1 Private ❑ Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date____________________) No ❑ New Construction: Yes 14 No ❑ FHA/VA: Yes ❑ No ❑ 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----_----------Distance from foundation___1v__________-Material_C-0-N:1�-f__e.7��-----_------- _ D4No. of compartments_..__..._`D..-.-----------Size---3.Xj6.l----_---Liquid depth--------------------------Capacity.... . Disposal Field: Distance from nearest well-------------Distance from foundation----jr'.---------Distance to nearest lot lit ng_.. ----------)j Number of lines_____,f_____.. __ Length of each line------�U--___�-_-___._.Width of trench...��_____----------------- WType of filter material----- of filter material------ _ --------Total length------------------------------------------ 0_0 Seepage Pit: Distance to nearest well---------------- ----Distance from foundation--------------------Distance to nearest lot line_.___-_.___.___ f ❑ Number of pits----------------------Lining material--------------.--------Size: Diameter------------------_----Depth..................--------------- T" Cesspool: k Distance from nearest well-----------------Distance from foundation--------------------Lining material__._..._._____________.._____-____.- -Size: Diameter--------------------------------------De th------------------------------------ .Li uid Ca acit Privy: Distance from nearest well--------------- __Distance from nearest building------------------------------------------0 Distance to nearest lot line------------------------------------------------------------------------------------------------ y re f' Remodeling and/or repairing (describe):---- ---------- ---------•------------------------------------------ ------------------------- ------ --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Z -------------------------- ------------ ---------------------------------------------------------------------------- - -------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work.wili be done in accordance with San Joaquin Court ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. v0� �{Si ned�- - ----- -------` �--- -- - ---------------------------- --- ----- -----------------(Owner and/or Contractor) . B (Title)_ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). y FOR DEPARTMENT USE ONLY APPLICATfON ACCEPTED BY = ----------------------------------------------------------- DATE-h_—_e3-d----&--�- REVIEWED BY----------------------------------------------------------------------/ - - a_---------._ DATE ^------.-_-------- TD - -------------------------------------- DATE - ----------------- �-------- 1 `ZfT ----�-"--*.�,.ei...�"----az-c..�—..i-i -- -- - -- ---Alteraatons a 'd � - ` .--------------------------------- --------------- -------------------------------------------------------------------------------------------------- --------------------------------- # y - _ FINAL INSPECTION BY: � � ___ � Date__.___._�C_._. /�__-1 _--------------- ___ SAN JOAQUIN LOCAL HEALTH DISTRICT ` r 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy, California F.P.C O. ' -