20260 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: .. ----------------------------- ------------ - eZ U 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 compliaa with County Ordinance No. 549. ` 1%1-140-.17 1-4-rHROP I ?p E r .P�vP-%t4%" 'S ASO' f ADDRESS AND LOCATI /-P—T-HRO-P-------RD--------- ------- ----- JOBQom- V QNl Owner's Name--------------r--1-t-------to-.------1-1 auh-w)--------------------------r------------------------------------------- Phone Address------------------------------ -I..�. _ _I•- ----------CT..I.-----------------•----------••------------•--...-------•---------••--------•------------•------ Confiractor s Name---------------Ch.R-6,4.Lf;;�n ---------------- ----------------—-- ---------------• •----- •--- Phone----------------------------------- Installation will serve: Residence,UR`�Apartment House 0-,Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units:`I_-!t_-._ Number of bedrooms -� / *_.�- - ._..�. ._O _ Number of baths Lot size . : Water Supply: Public system [Community system El Private El Depth to Water Table ..7?__ 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.----- ....I No New Construction: Yes [? Ilgo ❑ FHA/VA: Yes ❑ No TYPE"OF-INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if publicseweris available within 200 feet.) �O�C�I*T� Septic nk: Distance from nearest well --Sw--Distance from foundation---�SJ_--.-.-....Materia.-......---_...___- �. L ,� q f'o 1 No. of compartments-------�.-----.-----Size--�-x__1-x--,�Liquid depth-----�"f.. ---z.�.....-CapautY----�s---------------- Disposal Feld: Distance from nearest well- C!. --.Distance from foundation.___ _-_-.....Distance to nearest lot line---S7..__ Q le Number of lines---------- _ Length of each line--__--/-Q „_..Width of trench-."-�. r --.-- ---- , ... ----a.. Type of filter material---R�-�-K----Depth of filter material.......__/9___._Total length_...__ ..._...._--,1....�....-- --- Seepage Pit: Distance to nearest well-------.--------------Distance from foundation -------------------- --meter Distance tonearestlot lane-'------------- Distance fpits..-...._.`-_---..._ Lining material-----------------. . - , P ) ❑ Number o from nearest-well ._A .___.Dista-" from foundation-------- ----- ----Lining material. ------------------- Cesspool: w F-1Size: Diameter------------------------------------ -Depth--------------------- ------- -------------------- Liquid Capacity gals. Privy: Distance from nearest well----------------------------i--------------------Distance from nearest building----.i�,-_---------___--_.-....------- [] Distance to nearest lot line-------- ------------------ ------------ ----------------------- ----------------------- k y � Remodeling and/or repairing (describe)-------------- ---- ------------------------- --•--------------------•---------•------------------------------- -- ---------------------------- ---------------------------------------------------------- ---- i ------------------------- ------------ ------------------------------------------------------------- ------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------- I hereby certify th t I have prepare this application and that the work will be done in accordance with San Joaquin County ordinances, S aws and r sand a ulations of a San Joaquin Local Health District. --------------------------------------------------------------------------{Owner and/or Contractor) (Signe -- ------ - ---_-------- - -e- - - By-------------•-------------------------------------------------------------------- `a--------------------------- -----(Title)----- --- ----------------- -------}------ -------- - -- - (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be laced on reverse side. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY t.. - - -------- --------- ------------------------------------------------ DATE -...'.�� REVIEWEDBY------------------------------------- ----------------------------------- ---------- --------------------------------- DATE----------------------------------------------------------- BUILDINGPERMIT ISSUED------------------- ---- - --- -- --------------------------------------------------,.-;. Alterations and/or recommendations- ---------------------------------------------------•-----------------------------------------•------•----------•-------------------------- ------------------ - ------------------------------------------------------- -------------------------- -----------------------------------------------I------------------------------------------------------- •---------- - -------------------------------------------------- -------- -------------- --- - ---------------------------------------------------------------------------------------------------------- — 9 FINAL INSP ON BY: Date----------------------- 7------• ---- -- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street ]24 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California