20920 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: ------------------------------------------------------ APPLICATION FOR SANITATION PERMIT Permit No. aQ. .. --------------------------------------------------------- ------ - ---------------------- ------------------------- (Complete in Duplicate) Date Issued This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein descrbed. This application is made in compliance with County Ordinance No. 54.9. 0 X13-Z.3 - O� JOB ADDRESS AND LOCATION - -- ----- I? -------------------------- Owner's Name----/ �-------------- - •------------------------ - ----------------------- ------ Phone---------------------------------- Address ------------------ -- l C ? +� - Contractor's ---------•--•-•----------------•-------------------------------------------- ---------------------------------•------- Phone-------- ------------•----------- Installation will serve: Residence R1 •Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: /------ Number of bedrooms _x,?___ Number of baths -;-___ Lot size ... . .-. __ -t -- -----•--•-------- Water Supply: Public system ❑ Community system ❑ 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: Ilf yes,date. --------------) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (Na septic tank or cesspool_permitted if p_U_blic sewer is available within 200 feet.) Septic Tank: Distance from nearest well--------------.-.Distance from foundation--------------------Material-------.-.-.-.-..._____. ❑ No. of compartments----------------- --------Size---------------------------- ---Liquid depth---------------------------C7_ Capacity------------------------ Disposal Field: Distance from nearest well.-_a..-----Distance from foundation.. . .--.-...Distance to nearest lot line'+hl------------- Od Number of lines-.-----. ... ------- -- of each line------q-0-1---....____.__Width of trench....i-_�_r— -------------------- Type of filter material== �_______----.Depth of filter material_____IP-.--.._____Total length----f 4..................___------- Seepage Pit: Distance to nearest well__- ----....Distance from foundation_.Sl"r.IQ-----------Distance to nearest lot lineC---------- Ik Number of pits---- _---------------Lining material. ----------Size: Diameter------>33Depth__d'f---._..-..-__._-.-.__.. A 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 (describe):--- ---,lL�-- --•------------------------------------------------------- ,4 -------------------------------------------•------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•------------------------------ -- ---------------------------- ------------------------------------------------------------------------ ----------------------------------------------------------------------------------------------- -------------- I hereycertify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)---- - --------------------------------------- ---------------------------------------------------------------_(Owner and/or T ratter) y __... - g == === ---------------= ---- -------(Title). ------------_-----_ --------- ----------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). _ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- ------------- --------------------•----------------------- DATEr� ---!'-_i; _dir--------------------------- ---- REVIEWEDBY------------------------------------ ---------------------------------------------------------- ----------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE--------------------------------------------------------- --- Alterationsand/or recommendations:--------------------- ------------ -- - -------------------------------------------------------------------------•-•-----------•------------------------------- -•----------------------- ----------------------------------------------- ------------------- -------------------------------------------------------------------------------------------------------------------------------- ---------------------------------I------------------------------------------- ----------------------------------------------------------------------------------•------------•----------------- ---------------------------- FINAL INSPECTION SY:.. ."1.A4 Date. .___/. . SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:alton Ave. 300 West Oak Street _ 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO.