20623 - Laserfiche WebLink

Home Browse Search

� ' FO OFFICE USE: ff `' Permit 'lo. 'z . �� - APPLICATION FOR SANITATION PERMIT --------- -------- ------- ---------zf - p Duplicate)- �¢ � --------------- 11, _ _---- (Complete in Du llca#e) Date Issued r. 1F--------- ------- 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. L Elop ---------•------------ JOB ADDRESS AND LOCATION___.-- ---- ------ - ------------- E ' Phone------------------------•----•----- Owner's Name----------------------- - ------------- ----- t --- Contractor's Name---------_____________------------ -- ----- - - - ------------------------------------ ---------------- - - -- In will serve: Residence Apartment House F1 Commercial ❑ Trailer Court Motel [3Other C] I; Lot size -------- �✓ QQ-•--------------- i Number of living units: --_�_ Number of bedrooms -!-._ Number of baths --� !E Water Supply: Public system F1Community system ❑ Private X Depth to Water Tab le ((f ft. Adobe Hardpan ❑ E Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Previous Application Made: (If yes,date--------------_. --) No New Construction: Yes ❑ No FHA/VA: Yes E] No TYPE OF INSTALLATION AND SPECIFICATIONS: i (No septic tank or cesspool permitted if public sewer is available within 200 feet.), • _ Material-_.. _ -_ --------------- Septic Tank: Distance from nearest well__------Distance from foundation--- -- -------- - Capacity- -------- 1, f� I, No. of compartments------- ---- Size X---•Liquid depth------� ----------- Ix -/ i t !, E' Distance from foundation__--��--�-----Distance to nearest lot line____ __________ Disposal Field: Distance from nearest we 0------- Aar Number of lines_____-__-_a----- ---- ___ Length of each 4ine_-j�tt_"-- Q------- Width of trench.__sa�-----�------------ a� ♦i Total length------- _0------------------ j Type of filter material__--� ---Depth of filter material__-/ip. ---_- -- Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line---------------._ Number of pits----------------------Lining material----------------------- S ze: Diameter -------- - Depth-------------------------------- it ❑ --------------------------------- Cesspool- Distance from nearest well----------------- from foundation--------------- Lining Capacityterlgals. d ❑ ------ q -------------------------- .. Size: Diameter = Depth IE .-_Distance from nearest building------------------------------------------ Privy: Dis#ante from nearest well---------------- --__----- ! ------------------------------------------------------------------ Distance to nearest lot line----------------------------- - ---- -- i� ❑ E Aemodeling and/or repairing {describe):__.________________________________ _____ ! ----------------------- - --------------------------------- --- ----------------------------------------- ------------------- 1 I hereby certify Lha# i have prepared this application and that the work will be done in accordance with SanJoaquinCounty I ordinances, State laws, and rules and regulations of the-San Joaquin Local Health District. ----(Owner and/or Contractor) B -------- -------------------------------------------------------------- --- -- --- ----- ----- - -- ------------------------(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 �€ ( tee � P DATE------ l I�,APPLICATION ACCEPTED BY_-__--_.___-1- - - - - --- DATE------------------------------------------------------------ .,�REVIEWED BY-------------------------------- --------------------- ------------------------ DATE - z ----- BUILDINGPERMIT ISSUED------------- -------------------- ------------------------------------------ -- il"Alterations and/or recommendations---------------- -------------:------- ------------------:-•--t------------------------------------------------------- --- Il --------------------•----- ------------------------------------•---------- ------ {€' ------------------------------------------ -- ------ --- ----- --- ----- i' E!, FINAL INSPECTION.BY------------- -- --- ----------- Date =S y ------------------ - - - A O UIN LOCAL HEALTH DISTRICT i, 124 Sycamore Street 245 West 9th Street a 1601 E.Hasellor?-Ave. 300 West Oak Street i; Lodi,California Manteca,California Tracy,California j' Stockton,California F.P.Cd.