20893 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: =------------- ---------= --- --------------- - APPLICATION FOR SANITATION PERMIT Permit No. .__ �J___.._. 3 in Duplicate) ------- ------------- ------- _ (Complete P ) bate Issued -----------------_-------------- ------------ ----------- This Permit Expires 1 Year From Date Issued Os3 - d gO--0Vy 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 compliant with County Ordinance No. 549. 2-o zrA<t,. xv , JOB ADDRESS A CATION-712___-_ ------ - - - �`3`°` _ _ -- --- jk Owner's Name - ----------------- - ---------I-------------------- -- -----.-------------------- +.... Phone ==: ------------- ---- -- ------ - Address------------------ - -- _ --- -----------------------------------------------------•------•-------------•-- . f J , Contractor's Name------ Phone Installation will serve: Residence E] IApartment Ouse Commercial ❑ Trailer Court ❑ Motel [IOther [ Number of living units. _ ,-__._ Number of bedrooms-"` �` • g •-- � _____ Number f baths -__.____ Lot size ____ -�+---. -------------- 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 ❑ Hatdpan Previous Application Made: (If yes,date--------------------) No ❑ New Construction: Yes ❑i No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) . � r Septic , ank.- Distance from" nearest well-_--s1�.__.._Distance from ioundalion----______----------Mateiia____.__ ____ •�`___4_ -Li uid de th---- -----._Capacity ¢p No. of compartments--------`� ---- ----Size_-- --_ -_�-- q P P Y Dispos field: Distance from nearest well.... __._Distance from foundation____1_-0 ....Distance to nearest lot liner ____..- � ----Length of each line--- -VQ------------------Width of trench-- ------ :-- tib VIP! a Number of lines.:�:_____�__._____._q� g t, Type of filter materiaLS_--11_.___.__Depth of filter material--------- length__._______S-____--_______.-�------? IIr ' Seeps Pit: Distance to nearest well---------r-b,,Q____-Dis#anGe fre foundation____.�_�'----------Distan�e to near lot I -------- _.Size: Diame r------3_3---- ----Depth--- Number of pits---�_.____ Lining materialV'_�_S_�_-!_.._ 9. Q Cesspool: Distance from nearest well____ ________Distance from foundation.--------._-----_Lining material...........................___.____.- ❑ Size: Diameter = t Depth_ ==}=-c---`----------------------- --------------Liquid Capacity------------------ --.----gals. -------------------------- Distance from nearest building Privy: Distance from nearest:well ----��--ry- ' ----;'---. ._ � 9------------- ------------------ ----- 0 ❑ Distance to nearest lot,line_..._.- ---------------------- r-- ---------------- ------------------------------ ---------------- =------- - Remodeling and/or repairing (des .be �° �,�`.._a . - - --- ---------------------- ------------------------------- --------------------------- -- --= -. .-,.,. "� - ------ ----- ------------------------------------------------------- --- ------------------------------------------------ ------------------------- -- _ •. .__-__k_________________________________________-------_---------------------------------------------_--------------------------------------------------_______________ I hereby certify that I have prepared this application and that+lie work will be done in accordance with San Joaquin County k ordinances, State ws, and rules and reulations of the San JoaquinrLocal Health District. d v � r -.�--- - -------------------------- (Signed) and/or Contractor) --- N By:.- ' � - -- ------ -- - ------- ---- (Title) _ b- -' . .� .-� (Plot plan, showing size of-lot;'�1oca+ion`of sys+ tn relation fo wells, buildings,"etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_ -------- ---------- DATE_____Z� " --r---- � -•! "--- ----------------- -- --- ----- REVIEWEDBY----------------------------------- DATE------------------------------------------------------------ i BUILDINGPERMIT ISSUED---------------r------------- --- ------------- DATE---------------------------------------------- ---------- -- Alterations and/or recommendations e--------------------- - --------------•--- ----------•-------------------------------------------- ----------------------------------------1•---------------- --------------------------- I I -- ----------- ------------------------ ------------------------------ ----- -------------------------- --- L 9 -� FINAL INSPECTION BY:z" - �-------------- Da#e --`----- --- ----------------- ------------------------------- i SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street stockion,California Lodi,California Manteca,California Tracy,California F.P.G . F