19487 - Laserfiche WebLink

Home Browse Search

OR,OFFICE I` USE: f ----------- .� APPLICATION FOR SANITATION PERMIT Permit No. ------ ----- -------- -- ---- ---- (Complete in Duplicate I --. - ..--- This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to co sct and install the wo..k hg�ein described. This a ficatior}'is made in co liance with County Ordinance No. 549. /� c��.fr •v �G : } _ S AND LOCATION_ JOB ADDRESS I'! --•--,�-f=��--� ---��'_---�1�_�`�'�-'��:�------------�>t��i��.��.�---�-C:s/_c�-ST_.S�`,�. ( Owner's Name_�I .!1 f`� /�� ---------------------------------------------------- Phone ` Address lir ------ ----•--,-------------��✓-------------- -----------------------------------------•-- Contractor's ------------------- ---------------------- Installation will serve- Residence [Apartment House El Commercial E] Trailer Court ❑ M ff�1 ❑ Other E] Number of livingunits: _ Nu _ _ mber of bedrooms __ _- Number of baths ..__ Lot size ....... Water Supply: 'Public system ❑ Community system ❑ Private [Depth to Water Table '129- ft. ! E Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam © lay ❑ Adobe [] Hardpan ❑ l Previous Applicail tion Made: .(If yes,dote------------- No [ New Construction: Yes E] No Ej�- FHA/VA: Yes ❑ No R- - � TYPE OF INSTALLATION AND SPECIFICATIONS: p R (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_________________Distance from foundation--------------------Materiai-_.._____.________..______-_________._________-_. ❑r3CY� iI No. of compartments----------- -----Size--------------- ------------ k- --- -- ---Liquid depth----------------------- -Capacity----.----- ------ 1 Disposal Field: j� Distance from nearest well- >P_ ___Distance from foundation__/.�__`--.__Distance to nearest lot line__r�. Length,of each line_�Q_. X:7.:�.30.�4 clfh of trench----- ? `--------------- Type -----------„- Number of lines________________ [, T e of filter material_ _ r' yp _Depth of filter material__Zo__'_____________Total length_-_-___�� -______----___-_______ Seepage P', : Distance to nearest well__©l...Distance fro foundation_V.y'-.__. Distance to nearest lot line___ Q`� Number of pits-------- ----------Lining material__ - Size: Diameter_ i...... Depth---- --- -------- Cesspool: Distance from nearest well__x.._._____ ---Distance from foundation--- -----------------Lining mater ial----.----------------___------------- I f ❑ Size: Diameter----- '---------- ----------------- Depth--------------------------------- -- Liquid Capacity = gals. Privy: i ° Distance from nearest well___ ______________________r---.-----___.----:---Distance from nearest building--------------._____---------___------.-- ❑ Distance to nearest lot line_' ------------------ - ----------------------------------- Remodeling and/er repairing (describe)________ ------------------------------- -------•---------------------------- --------------------------------------------- I I hereby certify that I have-prepared this application and that the work_will'6e done in accordance with San Joaquin County ordinances, State lawsend--r s and regulations of the San Joaquin Local Health District. (Signed) = = I-S_l'� .,--.---� .._✓S/- = - _______________ wne and/or Contractor) By------- i --5 -------------------------------------------------t (Title)_..._ _ . (Plot plan, showin size of lot, loc ron of system in relation to wells, buildings, etc., can be placed on reverse side). I 1� FOR DEPARTMENT USE ONLY 'il f` fes- �-`-1� f APPLICATION ACCEPTED BY ---- :-- -- DATE REVIEWED BY-__i DATE ----- -------- ------------------ - ------------------------------------------------------- BUILDWG PEWIT ISSUED- ----- --------- -----------------.- D4ATE. Alterations and/or rec mrpendations•______________--<2/ -_---- ---------------- -------------------------- ------------- ------- �`•--- -------- ----------� - -� ----------- --------------------------------W - -- ----------------------- - ------------ ! `° - ----- -------- - - ------------ -------------------- ------- - -- ----------- - -- --------- -- I FINAL INSPECTION BY:_.__.... /; `' ------------------------ --------------------- Date-- SAN ate-SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.H`aielton Ave: 300 West Oak Street 124 Sycamore street 205 West 9th Street Stockton;California Lodi,California Manteca,California Tracy,California F.P.CO.