22077 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: ----------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ._d2. .- � ----------------------------- --------------------- -- (Complete in Duplicate) �p Date Essued � P.—�� ----------------------_----_---_---_----------------------- This Permit Expires 1 Year From Date Issued Application is hereby made to he San Joaquin Local Health District for a permit to construct and install the work herein described. This ap )'cation is mq4e,in pliancy with County Ordi ce No. 549. JOB AL'64S�AN L CATION--- - -------------- ------------------------ Owner's Name t`'''om - Phone ------- ---- --- - -- Address '-------- ------- ------------------------I----------- J ... i Contractor's Name-------- -- - - ----- --'`-='�---- ---- ------ ----------•---------------------------- Phone----------------------------------- Installation will serve: 'Residence IApar ment House ❑ Commercial ❑ Trailer E] E] [-]r Court Motel Other Number of living units: __ _._ N umber of bedrooms-_ Number o baths _-C___ Lot size ---- ------------------------.--.-_ Water Supply: Public system ❑ Community system El Private pth Water Table -------- ft. Character of soil to a depth of 3 feet- Sand E] Gravel ❑ Sandy Loam 7Gay Loam 0 Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: {If yes,date....................I No ❑ New Construction: Yes ❑ No ❑ PHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Distance from nearest wel!___`�0_...._Distant from foundation----.-. �--.-.Mat ria)--- Septic/Tank: . FT No. of compartments-_-__---------..__Size ��,tY_� �/Y_-. (Liquid de`th______ __..._-_Capacity__/_- Disposal eld: Distance from nearest well._!�P-------Distance from foundation..../9---------Distance to nearest lot iine_..$___--_.____. Number of lines._.--_. ._ Len th of each line----� -- ----------------Width of 'trench--- __-- -- - --- g -Type of of filter material____..__��__-`R.,-_Depth of filter material______I__f___-_.__._Total length---2-. 41_._.---__---.-.__-__-. Seepage Pit: Distance to nearest well----------------------Distance from foundation----------------__Distance to nearest lot line----------------- E-I Number of pits----------------------Lining material--------------------{.-:Size: Diameter-----------.-----------Dept h.....-----------------.---------- --Sh Cesspool: Distance from nearest well-----------------Distance from foundation ____-___.......::Lining material---------_---------------------------- Q\ E ❑ Size: Diameter----- I--------------- -------------- Depth-------------------------------------- -------.Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----_-----------------------------_--_- ❑ Distance to nearest lot line-- --- ----------------------------------------------------------------I------------- ------------------------------- ----------- t - F ,..1 Remodelingand/or repairing (describe):---------------------- ---------- ---------------------`------- ------------• ---------- ----------------------------•-------------------------------- I L_ ------------------•-------•-------------------------------------- ---------------------------------------------------------- ------------------------------ ------------------------------------------------------------------ ,i --------- --------------------------------------------------------•-----------------------------------------•-•----------------------------------------•------------------------------------------------------- -------------- E - 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, ain*1674 and regula ' of the San Joaquin Local Health District. I (Signed)------------------------- -- -- --- and/or Contractor) B - -- -- - --- ---- - -------------- -------------- ----------------- -- Y•---------------•---- -•---- - --- ----------•--- -- -- ---- --- ------ --------------------------------------------� (Title)- --- _ (Plot-plain, showing size'of lot, location'of system in relafio to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --------------- --- ----------------------------------------------- DATE -"f -- ._ T.:.__ . _.. . REVIEWED 'BY--------- --------------------- ------------------ ---------_----------------------------------------- DATE----------------------------------------------------------- BUILDINGPERMIT ISSUED----------------------------------- ------------------ ----------------------------------------------- DATE-------------------------------------------------------------- Alterationsand/or recommendations:-------------------------------------------------------------------------------------------------------------------------------------------------------------- a --------------------------------- -------------------------------=---------------------------------------------------------------------------- --------------------------------------•---------------- --------- I -------------------------------------•-----------------------------I--•--------------------• -----------------------•------------------------------------------------------------------------------------------------------- i I. ------•----------------------------------- --------- - -------- --------- ----- ------------------- --------------------------------- ----- - -- -------------- ----------------------------------- ------------- FINAL INSPECTION BY:---- 'f --------------- Date- - -- ----I----- --------- f E SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Waxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy, California F.P.CC.