21086 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: ----- --------------- -------------------- APPLICATION FOR SANITATION PERMIT Permit No. .. .. ------_------ ---------_.._.-------------_- (Complete in Duplicate) Date issued _-_ ---------- !---------------------------------------- --- This Permit Expires 1 Year From Date Issue 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. JOB ADDRESS AND LOC�TIN_/Ir- ATI �?! c�o �r1 `I�Owner's Name-----------> .. - ------------ Address Phvne ------------- Address----•---- fs ------------------ -- --•-----------------------------------------------------...-------------------------------------- Contractor's Name--, `-�G------------------•-••------------------------------------- ------------ -- -------------------------------------- -- Phone........--------------------------- il J Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer * Motel ❑ Other ❑ Number of living units: 4----- Number of bedrooms -L--. Number of baths ----- Lot size ii-------------------------------------- Water Supply: Public system [3 Community*system E] Private ❑ Dep li-to Water Table/�- ft. Cha'racter of soil to a depth of 3 feet: Sand ❑ Gravel E] Sandy Loam ��, Clay Loam R] Clay E] Adobe E] Hardpan 91 Previous Application Made: (If yes,dote_---.--_,-_.. .-I No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ ,r TYPE OF INSTALLATION AND SPECIFICATIONS:\ (No septic tank or cesspool permitted if public sewer is available within 204 feet.) U.I �f p G� Material-------------------- -- -- l Septic Tank: Distance from nearest well-l:�-4--�-Distance, from,ifoundation____. -.-_---_- _. _-----------� No. of compartments-.�----- ---------Sizes ��-----:---Liquid X4 No. —Nm---------- rr_ O from foundation._-Z-0...-.._..Distance to nearest lot line---i1--- ....... -------------- 9 --- ------------.Width of trench- 4�------------------------ Type .--------------------- Disposal Field: Distance from nearest well Distance each line Number of lines___--�---- - -_ Length of 7 e of filter material _s, Depth of filter material...1Q-............_Total length-c>_7-_-&0----------------------------- Q Seepage Pit: Distance to nearest well.)-M--_-.-.---Distance.fr-om foundation_(Q.............Distance to nearest lot line--�--.-.------ Number of pits----- -------------Lining material-- -----..Size: Diameter----a- -"---------Depth- .r----------------------- Cesspool: Distance from nearest well ---_-........--Distance frrom foundation--------------------Lining material--------_.-------_-.------.-------.-. Size: Diameter ---------------- ------------Depth---- ---------------- ------- -- -- Li uid -Capacity---. els. q P Y----------------------------9 Privy❑•. Distance from nearest well----___-----------F' ----- -------------Distance from nearest building------------------------------ -----. `----- -------------------- - ❑ Distance to nearest lot line------------------------ _ - - ----------------------------------------------------------------------- ,, .'modeling and/or repairing (describe):__�i/y,F"r'.- - -. -- -�'!�`+'h:- ------ -----•-------- -------- R ----- ---------•-------------------------------- - :-------:------------------------ --------------------------- ------------------------- ------- -------------------- ------- 1( -------------- -------------------- ° � I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County orjd inances, a laws, and r es and regul ions of the San Joaquin Local Health District. N �. (Sined( AA"l L. --------- 119 -------------------------------------------------------------------- --------------------(Owner and/or Contractor) By:.. ----------•------------•--•------------•---------- ----------------------------- ---------------------------------------------(Title)- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). r li FOR DEPARTMENT USE ONLY f APPLICATION ACCEPTED BY -- ------------------------------------------------------- DATE.72res'G ------------------------------ REVIEWEDBY-------------------------------------------------- -------------------------- -------------------- ------ DATE------------------* ------- ---------------------------- BUILDING PERMIT ISSUED ---`- ----------------- DATE ------------------ Alterationsand/or recommendations:. --- ------------- ------ ------ -------------------------•------------------------•---------------------------------•-------------------------- a - --- ------------------------- -------------- - II --------------------------------------------------------------------------------------- -------------------------------- --------------------------- - ------------------------------------------------------------------------------------ ---------------------- -------------------- -------------- ----------------- :I INAL INSPECTION BY;4�••- .e -.-- ---- Date..? --------•- ---------------- ----------- ---- ---------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hatelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California r F.P.CC. - ti