22466 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: ............................ � ------------------------------------------- --------- APPLICATION FOR SANITATION PERMIT Permit No. . . ----- ------------------- ---------------------------- (Complete-in Duplicate) Date Issued _...... ...........1....-.-__---__- ___ 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. � � � � �—p JOB ADDRESS A LOCATION _ _�Z _ _1rn�sQ...C__.. __; .__. _ /� Owners Name------- ------- --- � --• --- -- --------- -- -- --------- ---- --- --- ---- --- ---- --. Phone-----•---------------- ------------ Address--------------------8116-----SC 4l- -------- ,------ --•--- -- ---------------•-----------------.--------- Contractor's Name n -s � t-- X----- ------- ------------------------------------ Phone__fi�+' f Installation will serveResidence A� a House Commercial Trailer Court Motel Other ID Number of living units: __/_._ Number of bedrooms . Number of baths-1 _:',Lot size Water Supply- Public system ElCominunity system ❑ Private ,Depth to Water Table ------ _ ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loamj?CClay Loam E] Clay j] Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date__------ -------- ) No K New Construction-. Yes-15CNo ❑ FHA/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 w/e�ll� .._----Distanc�ifromyfoun tiQ➢__��,Q-` .____ Material _" - _._____._____-___. No. of compartments___ .t-_._.-----------5ize_ __.? Liquid depth___ j�!._..Capacity-_-/ D _ Disposal Field: Distance from ne est well. '� Distance from foundat' rt---U- Distance to nearest lot line__ .-.-_--- 4 Number of line____ ____________ ________Length of each line--��!-_- -_..__.__-.Width of trenchc�'�X�___-_--.. -_ Type of filter mater- p � g :._....De Depth of filter material---_..I .--___--__._Total length ____._.._____ Seepage Pit: Distance to nearest wefl__ __----- _____ ___Distance from foundation--------.-----------Distance to nearest lot line----------------- El 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 --------------------------------------------------------------•------------------------------------------- - ------------------------ Remodeling 'and/or repairing `describe)'---------- ---- ----- ---------- -- -- -------------------------------------------------------- ---------------------------------------- -------,• -- - ---------•-------------------------------------------------------•--•--------------------------------•---•----------------------------------------•-------------------------------------•--------- -------------------- ---------- ------------- ------------------------------•------------------------- `----------------------- -------------------------------------------------------------------------- ------------------------� 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 of Ai San Joaquin Local Health District. ,. m .. .---��,,,,-� _� (Signed). -- •-..•- - -- - ------ --- -- ---- ----'....... - ---- --- --------- -------------- --- ontractor) B . i E = Y -SEpT7>: T N}C �Rvr --------- `------------ (Title- - - (Plot plan, shovIm idw �ot,.IgtWq g system in relation wells, builds, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----. 1 -------------------- -------------- DATE--��^ __..�_ -------------- ------- REVIEWEDBY---- ---------------------------- --------- ---------------------------------------------- DATE----- ----- BUILDING PERMIT ISSUED-------- ..- DATE--------- - ------------ Alterations and/or recommendations:----------------------- -- ----------------- ---L----------- ----------- ---------------------------------------- ----------------------------------------- -•---------------------------------- --------------------------------- -- ---- -- ----- ------------- ----------------------------------------------------------------------- ----------------•------------------------- ------------------------ --- -- -------- -------------- --------- ------ --- ----- -------------------- --------- -------------------------------------- ........ - -- ------------------------------ FINAL -- --------------------------FINAL INSPECTION BY:--- . Date - - - - --- ---- --- ------------------------------------ -- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi California Manteca, California Tracy,California 1� E.H.9 2M 1-67 Vanguard Press 3