20755 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE.... --------------------------- ------------------------ r .. _______-____._____.__._____._..- _ APPLICATION FOR SANITATION PERMIT Permit No. ..2 ---------------------------- ---- (Complete in Duplicate) Date Issued ------------------------------------------------- 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 herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION � -----------------------------------------V---------------------------------------------------------------------------------- ly-b--------------------------------------------------- Owner's Name- -------------------• - ----------------------------- --------------------------------------------- Phone....---------------------------•--- Address _ �_ c4-ij r ` a `' _ �_ _ p -------------------------------------------------------------------•--------------------------........ Contractor's Name --•_K!� I -------------------------------------------- Phone Installation will serve: Residence [/Apartment House ❑ i Commercial E] Trailer Court ❑ Motel E] Other ❑ Number of living units:----/__ Number of bedrooms ____!__ Number of baths ---- __'Lot-size ----- ___ O�___.-______________________ Water Supply: Public system ❑ Community system Private ❑ Depth to Water Table ._C__ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam (1r'Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No Z�--New Construction: Yes ❑ No Rr F A/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest we11A10A1e> _-__Distance from foundation__. 9----------Mate ial---Pf --------- -------- P/ No. of compartments_--------�-______.__Size--------------------------------Liquid depth__--- -------------.-----Capacity---hP�q------- Disposal Field: Distance from nearest well-N ___Distance from foundation__Z_V----------Distance to nearest lot line-----(o____-_-__ Number of lines-. ____ __--------------------Length of each line__/_7--- ....3d_------Width of trench_____ l___ _-_-_____________ Type of filter material__-___-_Depth of filter material___-/__�____-___Total length_____________-D---------------------- t Seepage Pit: Distance to nearest well-------_--------------Distance from foundation--------------------Distance to nearest lot line____-_____-__ ❑ 1 Number of pits----------------------Lining material-----------------------Size: Diameter-----.-----------------Depth----------------------------_.--. Cesspool: Distance from nearest well-----------------Distance from foundation------------------- material_______________________--_-________- Size: Diameter--------------------------- ------Depth----------------------------- ----------------------Liquid Capacity --gals. A. Privy: Distance from nearest well -_.------------------------------------------._Distance from nearest building__ -____________________-_. ❑ Distance to nearest lot line-------------------------------------------------------------------- ---------------------------------------------------------------------- r Remodeling and/or repairing (describe):---------------------------------------------- ----------------------------------•.•-----------------------------.......------------------------------- ------------- ------- ------------------------------------------------------------------------------------------ --------------- ----------------------------------- ------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify"thathave prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laes and regulat'ons of an Jo quin LocalHealth District. (Signed)-�------------------ - (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). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- __-- ___ --------------------------------------------------------------- DATE........ __^ -�v-_.A-________________________ REVIEWEDBY---------------------------------- ------ ------------------------------------------------------------------------------- DATE-------------------------------------=---------•----------- BUILDING PERMIT ISSUED---- ---- ----------- ------ ---------------------------------------------1. DATE---------------- -------------- Alterations and/or recommendations-------------------------------------------- ----------------------------------------••----------------------------------------------------------------- ---------------------------------------------------------------------- -------------•--------------------------------------------------------------------- ------------------------------------------------ --------------- ------ --------------------- ------------------------------ ---------- ---------------------------------------------------------------------------------------------------------------------------------------------------- ------ •-----•----- ------------ •----------------- - FINAL INSPECTION :----- -= ----------------------------------------------- Date----------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO.