20710 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: (K oo 14ey S-f-vie l APPLICATION FOR SANITATION PERMIT Permit No. --------------------------------- ------------------ -- (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 withC�ou ty Orclinanqoo. 549. JOB ADDRESS AND LOCATION a'- i�' _ - -� =� '"�' � ------------_------- Owner's Name------------ p� - --- t!2 �---------1� - -------------------- -------- --------- Phone--------I-------------•-------.- Address------------------------ f ! 0------------- Contractor's Name - ----•------ Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms ---/--- Number of baths ---1--- Lot size -----.------ "'d_.�`'1Da_______________________ Water Supply: Public system ❑ Community system Private ❑ Depth to Water Table __ --- 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 Er"No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if publip sewer is available within 200 feet.) !`.A Septic T Distance from nearest wellMM-1__Distan jpom fQ,undatiPfi---IQ_______... .Material ---___--_ No. of compartments_-------�-----_-__Size-- �_*�Q__� 6 Liquid depth__-S_f/ Capacity.•.I�W-------- f r Disposal ield: Distance from nearest well fiW__7 _Distance from foundation.. _Distance to nearest lot line---�,�________- Number of lines-----s--- ,r--/-_�-----__�_. Length of each line-SVQ--_-� ___/__O?�idth of trench------*2y _______________ Type of filter materiaLf�_----_l_� epth of filter material----IT_--/-----Total length----------ell_ -------------------- Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line__-__-__________- ❑ Number of pits-------------------_Lining material-----------------------Size: Diameter-----------------------Depth------------____-_._________ Cesspool• Distance from nearest well-----------------Distance from foundation------ _------------Lining material---____-_-_-_------__-___---._ ❑ Size: Diameter------------------- ---- ---------Depth---------------------------------------------------Liquid Capacity-_---------------=------•-gals. Privy: Distance from nearest well--------.----------------------------------------Distance from nearest building.-------------_______._.____--__.-_-.. ❑ Distance to nearest lot line-- ---- ------------------------------------------------------------------------------------------------- ------------------------------ f Remodelingand/or repairing (describe):-------------------------------------------------------------------------------------------------------------------------------------------------------• �Q ---------•-------•-----------------------------------------------------------------------------------------------•---------------------------------------------------------------------------------•------------------------ ----------------------------------------------------------------------------- --------------------•------------------------------------------------------------------------------------------------ --------------- --------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations o San Joaquin L cal Health District. ($i ned 9 ) ---------- = . -- ------ - (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--------------------------------------- ----------------------------------------------- ---- ----- ----- ------------------------------------------- REVIEWEDBY-----------------------------------_------- ------------------------------------------------------------- -------- BUILDINGPERMIT ISSUED---------_------------------------- --------------------------------------------------- - ------- AT - ---------' ------------------------------ Alterations and/or recommendations----------------------------- ------------------------------_•------------------------------------------ ..........R_ - --------------- --------------------------------------- -------------------------------------------------------------- ----------------------------------------------------------------- 1. .--- �. ----- -------------- -------------------------- ----------- .. -------- ----------------------------------------- --------------------------------- •- -------------------------- ------------ ----------------- ----- ---- - - -------------- - ------------- -------- ----- - ------ --------- - -- ----------------- FINAL INSPECTION BY:.--- -- -,` -��= 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.