19774 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: ---=----- ---------------------------- -APPLICATION FOR SANITATION PERMIT Permit No. -------------------------- (Complete in Duplicate) Date Issued t --------------- 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 her ' escn e . e This d 2 — f7�'application is—made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION-=-- -----------�--- -�- - ---- -- --------- -- - - -•-------- Owner's Name__ ------ ------------------------- ------------------ ---- ---- ------ one--------- Address------:;.: Phone_____________________ .3 -2,0-2,0Contractor's Name___ -- -- Y S ______________ Installation will serve: Residence '' Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___1--- Number of bedrooms 3___ Number of baths - Lot size ----------------- Water Supply: Public system ❑ Community system ❑ Private [rlseptb to Water Table _&f ft. Character of soil to a depth of 3 feet: Sand 0 Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan-❑ Previous Application Made:, (if yes,date________ ___ _______l No New Construction: Yes [B—No ❑ FHA/VA: Yes ❑ No E}' TYPE OF INSTALLATION AND SPECIFICATIONS: 2. (No septic tank or cesspool permitted if public sewer is available within 200 feet.) e _� .__._._.___. atena_____ __ ----------------- Septic _ Septic Tank: distance from nearest welL\�0---_ Distance from undationMCapacity----y1= _a tments_.___� ize � � xLiqwd depth �No. of compar .. -- -- ---------S ---- � Disposal Field: Distance from nearest well__4t`0_ ___---Distance from foundation__l4.`..........Distance to nearest lot line__ ____. ) ®/ Number of lines_____------------------ -----Length of each line__e0A--`--.----__-----_.Width of trench..__-1`._-_-f,`"------- ------ N - �l Type of filter material_ 4AC--------Depth of filter material_._./ _�_-------Total length______;Lv�r- ------------------- pQ i Seepage Pit: Distance to nearest well__./0Q:___.-..----Distance from foundation___!__.........Distance to nearest lot line__.-___.__ t Number of pits-----a--------------Lining material_ ----Size: -------Depth_._,94------------------ Cesspool: Distance from nearest well-----.--------_-Distance from foundation--------------------Lining material___---------------------------------- ❑_ S;tze: Diameter-------- ----------------------------Depth--------- ---------------- ------------ ------------ Capacity_ _M --: gals. Privy: Distance from nearest well------- -------------------------- -----------Distance from nearest building Distance ------------- -------- ❑ to nearest lot line------------ --------- ------------ - ---------- ------------------ - - ------------------------ ------------•----------------- --- - - Remodeling and/or repairing (describe)------------------------ ----------------------------------------------•------- ---------------------------------------------_---------------- -______________________ __________________________________________________________________________________________________________________________________________ ________ ` prepared this application and that the work will be done in accordance with-San Joaquin County I hereby certify that I have v ordinances, State w and rules r ulatio of the San Joaquin Local Health District. ` -------------------------------(Owner and/or Contractor) (Signed) -------------------------------- --------------- --- _ -__-- _(Title)------- j: (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 ACCEPTEB ------------ ---------------------------------------- DATE < — ------------ ----------------- REVIEWEDBY-----------W--.� --------------- ----------------------------------------- DATE-�4-'- 1Y --��--`�-------------------------------- - BUILDING PERMIT ISSUED------------------------ --------------- DATE----------------------- ='----------- ------------------- Alterations and/or recommendations:------- -------------------- --------------•----••----------•---------- -------- --- -------•----------------------------------- - --- ---------------------------- = --------- ��. --- --------------------------- FINAL INSPECTION BY: ----------------------_- Date - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hat:elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Mantecar California Tracy,California F.P.CO.