19932 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: �t✓f�� E'er ----------------- ------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. � . ------------ -------------------------------------------- 11401. ll (Complete in Duplicate) Date Issued --l _-�� -----------------------__.-------------------...__ This Permit Expires 1 Year From Daft, Issued Application is hereby made to the San Joaquin Local Health District foe a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No.149. JOB ADDRESS AND LOCAT N...__. J` I Owner's Name = =------------ - ---------------------•-------------- ------ Phone-------------•----------- Address---•-••-••••------alee ------ 1 --- ------------------ Contractor's Name------ .. ------ Phone................................... Installation will serve: Resi� e tj Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___1--- Number of bedrooms -1__._ Number of baths -------- Lot size --------0V_,y1- ----------------------- Water Supply: Public system ❑ Community system J9 Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date---.--------.____._-) No New Construction: Yes �o ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public Septic Tank: Distance from nearest welll&O- sewer is available within 200 feet.) 7� Distance,fr from foundation----/Q----------Material -he. No. of compartments_______:.._._a�.________Size__'7..1_X*_A1odiquid depth .___._____ Capacity....J0. Disposal Field: Distance from nearest well _ ._Distance from foundation_40�_.-__--..Distance to nearest lot line/__ ---------- o [ Number of lines________________ T� -0Length of each line--------- �'�9: -- ----_----------Width of french.---_off-y N Type of'filter mate ria I of filter material--------1- ----------Total length---... -- Seepage Pit:, -Distance to nearest well---------------------- from foundation_-__•-_-_-_-_-_--.Distance to nearest lot line______________-_ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Dept h_--__--_-__..__-------__--_--_ Cesspool: Distance from nearest well-----------------Distance from foundation__-:_.............Lining material-------------------------------------- 17-1 ________--___- ..._-_- --_- ❑ Size: Diameter------ -------------- ----------------Depth..--------------------------------------------------Liquid Capacity----------------- -------gals. Privy: Distance from nearest well------------------------------------------ ------Distance from nearest building------------------------------------------ f_1 __-_______,__-___-- _._-__-_-----_____❑ Distance to nearest lot line---------------- ----------- ---------------------------------•---------------------------------------------------------------------------- Remodeling and/or repairing (clescribe):- ----------------------------------------------------------------------------------------------------------------------------------------------------- --------------------•--•-------------------------------•-- --------------------------------------------------------•------------------------------------------------- ---------------------•------•------------------------ -----------------••-------------------------------------------------------------------•----------------------.-------•----•---------•-----------•-•------------------------ ---------------------------------------------- ----------------------------------------------------------•-•------------------------------------------------------------------------------. I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County f l ordinances, State laws, and rules and regulations o he San Joaquin Local Health District. (Signed)-------------------------- _-- ---- 1--= - -------------------------------------- --------- -----------(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 APPLICATIONACCEPTED BY--------- ------------------- ------------------------------------------------------------ DATE----------------_----.------------------------------- REVIEWEDBY------ ------------------------------------- ------------------------------------- DATE------ ---------------------------------------------------- BUILDINGPERMIT ISSUED----- -------------- ----------------------------------------------------------------- ----------- DATE`------------------------------------------- --------------- Alterationsand/or recommendations:----------_---------------- ------------------- -------•-----------------------------------------------------------•-------•----------------•-------------- •-----------•----------------------------------------------------------------------------------------------------------------•---------------------------- ------------------------- - ------------------------------- --------------------- -------------------------------•------ ------- -------- ------------------------ ------- --------------------- --•--------------=------------------------------------------------------------- ----------------- ----.--- FINAL INSPECTION BY:. 7 ,-� �- _... -------------------------- Date-/6--- 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.CC.