20065 - Laserfiche WebLink

Home Browse Search

FOROFFICE USE: APPLICATION FOR"SANITATION PERMIT Permit No. . Q _ _. ---------- (Complete in Duplicate) __-_.--. This Permit Expires I Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. 23 This�a2 �atl�r��om li nce with Count Ordinance Na. 549, CJ(P 3 Z JOB ADDRESS AND CAVO .ae.� y = C �1 •*a1'�✓ ------------------------ Owner's Name ✓ il' --- ------ ---------- Phone --- -------------------------------------------- Address ,---- — --- ----------- �� ----------------- ...--•-•- Contractor's Name-------- ---- ..--. Phone......................_---------- Installation will serve: Residence &-'Apartment House ❑ Commercial ❑ Trailer Court ❑ Mot 1 ❑ Other ❑ Number of living units: ___ _ Number of bedrooms _umber of baths Lot size Water Supply: Public system ❑ Community system ❑ Private to Water Table fto Character of soil to a depth of 3 feet: Sand E] Gravel E] San Loam E) Clay Loam ElClay El, Adobe lardpan Previous Application Made: (If yes,date..............._.._) No New Construction: Yes IVO ❑ FHA/VA: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: et '� (No septic tank or cesspool permitted if public sewer is available Ci#hin 200 feet.) r Septic Distance from nearest well-/a4-. -_Distance from foundation____/0-_J___-Mater'/I'.___. r- -- --it-1__ __ ------- S� No. of compartments.__.sr�______.__Size-_ � c_ It _Liquid depth--------- Capacity___ Disposal e d: Distance from nearest well_/_ _-.-._Distance from fouoat n__/ Distance to nearest lot I? --._._-.__. [ Number of lines------- -- ---------------Length of each I�nefs___ __-____.Width of trench__o _ _._ _____-._--.__-- T e of filter material___, _ �-t e th of filter material.... f! Total len th..../_0'Z7__1______________________ W Yp e Jg- p9' Seepage i Distance to neares well_ Cy4(______Distance, m ounclat�n---_� __.Distance to nearest lot lir _._ /441n, Dy Number of pits.__.- - --_..-__Lining material__ _!-----Siize, Diameters-34?�- _ii-,Deptn�l,�__�� N Cesspool: Distance from nearest well-----------------Distance from foundation------------------- Lining material------_---------------._---_______-_- ❑ Size: Diameter------ ----------- - --------------Depth------- --------------------------------------------Liquid Capacity-. -----------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building.____..._______.____________________.___.. ❑ Distance to nearest lot line---------- -------------------------------------------------------------------------------------------------------------------------------- Remodeling and/or repairing (clescribe)_-----_____ __ __ ___t J____S� __ ,l l ✓_____.___ ____ ---- ----- -- ---- ----------------------------------------------------------------------- -- -------- -- ------ ------------------------------ --------------------------------------------------------------------------------------------------- " --- . .r'I hereby certify that I have prepared-this-application and-that-the work-will-be'd'one'in accordance w' San Joaquin County ordinances, State I , and rules an" re ulations of the San Joaquin Local Health District. ��yy �� �j _ (Signed)_______________ ____Q� ._____ _�1 _ _ _ __._....___ _ _ - - .�-(Owner and/or Contractor) By:----------------------------- - -- asz......#_.�- - - {�.---------------------------------------------(Title) �: - '(Plot plan, showing size of o location of system in relation to'wells, buildings, etc., can be placed on reverse'side). FOR DEPARTMENT USE ONLY 0 3 . APPLICATION ACCEPTED BY ,-L DATE 2---- ----�------------------------------ REVIEWED BY-------------------------- ----- - ----- ATE_. .-------- - --- - -- - ---- ----------------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE---------------------------------------- -------------------- Alterations and/or recommendations:------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------ --------- ---------- ----------------------------------------------------------------------------------------------------------------------------------------------- ( ,_�\`` fNAL INSPECTION BY . - - - - -- --- =------------------- ---------- Date--�1-�-------------- V SAN JOAQUIN LOCAL HEALTH DISTRICT-. 1 ,/ ( '� i /, t� 4' r 1601 E.Maselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street . Stockton,California Lodi, California Manteca,California Tracy,California F.P.CO.