18393 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: ------------------------------------------------------- --.----_-----------------------_-------.-----.-----_--- APPLICATION FOR SANITATION PERMIT Permit No. -------•------------------------------------------------ (Complete in Duplicate) _.._.___. _ ________ ______ This Permit Expires 1 Year From Date Issued 1. Date Issued 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 Ordinance No. 549. L u7`C�r..rs5yf7`` " JOB ADDRESS AND ADON �'+ -2t __ = -- ------ - ''Z---- h_ltiJ� - Z -' _ f/ Owner's Namg- : I -- -r' Phorid'_ ---------••--- Address--- ------ --------� -------- { Contractor's Name----- L --•- ------ "-err- ------------------------ ------ Phone-- ---- 4- ------� Installation will serve: Residence ❑ Apar merit House [-] Commercial E] Trailer Court [IMotel E] Other E] Number of living units: ---- Number of bedrooms -------- Number of baths.aZ/__ Lot size _______�L ___________--- ______ Water Supply: Public system ❑ Community system ❑ *Private Depth toleWater.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;❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No'''septic tank or cesspool permitted if public sewer is available within 200 feet.). E , Septic/Tank: Distance from nearest welGPA_/__.__Distance from foundafion__,_�.-___ ____Mate al____ -PrY+� -__________. No. of com artments_ _ _________Size_ '�9 '�S � Li uid de th______``__ __._Ca ac U _ Dispos "f Field: Distance from nearest well . .S ./---Distance from o dation'.._ �_�. ___..Distance to nearest lot line, -___"_ -- _ .----------------Length of each line--�[ _- ------_I_____Width of trench-_---Z.__:�--_"'-------------- Number of lines__________ I Type of filter. material...t __ _____________Depth of filter materialL ------7___1.__.Total length_____-155�-_`-------_.------------ Seepage Pit: Distance to nearest well----------------------Distance from foundation ___._.._._.----Distance to nearest lot line.....`_.-.__-__-- � ❑ Number of pits----------------------Lining material------------------------Size}Diameter---:--_1".'1----------Depth-----:----------------''---------- Vj Cesspool: Distance from ❑ nearest we}_ _ __----_----Distance from-foTundaton_______"•.__- r material________'._.________._. . ___ Size: Diameter--------------------------------------De th------------- i-------- --- ---fLi uid Ca aci ---------�� ty---------- g_al_s_..:l Privy: Distance from nearest-well-------___________________________________ __�Distance;from nearest building-------_-------------------------------- __. ❑ Distance to nearest lot line________________ I --------- Remodeling - --Remodeling and/or repairing {describe):----ke,__Jt.----- •` ` k i __ r 1 # ______________________________________________________ __________;____ ,w { r f -- t I hereby certify that have prepared this application and that the'work will be doneiin accordance with Safi Joaquin County # ordinances, State laws, nules and regulations of a an Joaquin.,.Local Health District. ! F t .-, � 1 (Signed) _i____._____. or Contractor 9 )-------------------------- ---------------------- �- ------ -- --- By:--------------------- --------- ----------------------- -------------(Title)------------------------- ---- ----- (Plot plan, showing size o t, location of system in relation tofwells, uildings,.etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- ----- -----------------------------------------•---- DATE------ ---------------------- REVIEWED --------------------REVIEWED BY--------------------------------- ----------------- ----------------------------------------------------------------------- DATE-------- ------- ------------------------------------------ BUILDING PERMIT ISSUED. DATE 4= Alterations and or recommendations:______ __ �+_______/,t ��r-�_.__.- ______,fi !t.! •v/r _____ ,_-__ t p y ----- --------=-------------------------------------------------------••----------------------------------•------------------------- - ----------------------- ---------------------------------------------- ----------------------------------------------------- ---------- ------------------------------------ !. FINAL INSPECTION BY:.------ " Date --�-�---�5------------ -------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT f y 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ` ES 9 REVISED S-59 3M 3-'63 F.P.00.1 Via.-