19596 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. --------------------------------------------------- - (Complete in Duplicate) Date Issued - - - This Permit Expires 1 Year From Date Issued _ - liance Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein descri This application bed. PP onis made in om p with County Ordinance No. 549. �� •�'♦ �Q ---••-------- _ ------------ JOB ADDRESS AND A4� .--.Y_____ 1_" ------- � --- ____ _______ Owner s Name- ---------------U��_�.__.---- �---------- -��-�.-------- --- ---- - - ------- -------------- --- ------- Phone------------------------------------ iAddress------------f_�_TE _ J._-_------[3p-x-------2 --------------- --=----------•--------------------------------------------------- Contractor's Namer� _(� ----------------------------- ------- ---- Phone----------------------------------- Installation will serve: Resident Apartment House El Commercial E] Trailer Court ❑ Motel [:] Other /- ❑ Number of living units: __ ____ Number of bedrooms - - Number of baths _ --- Lot size ___%__x"_ 19?_______________________________ Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table 4_z.�_ 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---_----------_______) NoB' New Construction: Yes UT'-No ❑ FHA/VA: Yes ❑ No Er— TYPE OF INSTALLATION AND SPECIFICATIONS: t (No septic tank or cesspool permitted if public sewer is available within 200 feet.) . _ ` z -_ _ :._. _ - _ Septic Tank: Distance from nearest welL�� f -" Di"starice from foundation� --- lvla terial: e_ T-- --= O---- 2 _ No. of compartments__-_ _"---"" Size-"Y_X X__ Liquid depth___- �� Capacity----�------- Disposal Field: Distance from nearest !wellS_Q.-_Distance from foundation_____ -------Distance to nearest lot line______-_.__. Number of lines----------- : h of trench.----- �1 _�7Widt ? _."-""_-_-- __..___._ _.!______"____--______Type.of filter material_-- Depth of filter mMerial____.9Q__..____Total length Seepage Pit: Distance to nearest well------------_---------Distance from foundation-------------------Distance to nearest lot line-----_-__-___.._ ❑ Number of pits----------------------Lining material------ ---------------Size: Diameter----------------- -----Depth_.. -- -------------------------- Cesspool: Distance from nearest well ._________.----Distance from foundation-------____------_Lining material__._...____--__-_...___.________-__.". ❑ Size: Diameter------------------------------- -------Depth--------------------------------- ------------------Liquid Capacity- -------------------------gals. Privy: Distance frompearest well_______________________.__-__._____..._.____.__._Distance from nearest building.__.__-__.__._____-______._-___..------ ❑ Distance to nearest lot line- -------- ------ --- --------------------------------------------------------------- t Remodelingand/or repairing (describe):------------------------------------------------------------------------------------------------ ------------------------------••----•------------------- Ij -------------`"•-------------------------------------------------------------------------------- -------------------- ----------------------------------------------------------------------------------------------------------------- I 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 rules "d regulations of the San Joaquin Local Health District. j (Signed) y � 4 --------- --------------- Owner and/or Contractor) ----------- _ By:-------6/------------ ------- ------------------------------------------------- --------------------(Title)------ ---------------------- ------------------- •(Plot plan, showing.size of lot, location of s stem in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY q� APPLICATION ACCEPTED BY DATE------.,!__�.2I"._�'�---{'------------------------- -- DATE = REVIEWED BY------------------------------ BUILDINGPERMIT ISSUED---------------------------------- ----------------------------------------------------- ------------- DATE-------------------------------------------------------------- Alterationi and/or recommendations:----- - -------------------------- ------•"-------------------------------------------------------------------------------------------------------- i "- ----------------------- --------------------------------•------------------- ---------- -------------- -------------------------------------- ---------------------- ----- ---------•"- •------------ I FINAL INSPECTION BY:J .. � ------ Date----------------- �'� j I SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hatellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.Ca. j ..