19939 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: --------------------------------------------------------- q --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. 3 . --------------------------------------------------------- (Complete in Duplicate) -----..-.--- This Permit Expires 1 Year From Date Issued 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 inFcompliange with County Ordinance No. 549.. 2Zq 150--04 0_�-_Taf�_xJOB ADDRESS AND LOCATI �_._. 11� } 1F E Q !1� -----Oi------- ------------------- Owner's Name------------------ l `. ----------------------------------- Phone--------------- -------------------- Address . 1 � --=-JOAKM - ----- ----------------------------------------- Contractor's Name----- -QY = Phone� -5----------------------------------- Installation will serve: Residence ff Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ i Q V7 Number of living units: _- .--_- Number of bedrooms 13-- Numbdr of baths _2— Lot size ---- iR- --------------------- Water Supply: Public system ❑ Community system [I Private Depth to Water Table 3l$ ft. Character of soil to a depth of 3 feet: Sand E-] Gravel ❑` Sandy Loam ❑ Clay Loam [Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: {If yes date....................J No New. Construction: Yes Wj-< [j FHA/VA: Yes ❑ No __ TYPE OF INSTALLATION AND SPECIFICATIONS:. h (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r Septic T k: Distance from nearest welt---.510.__-- Distance from �-y � - foundation----�ff-------.Mater�a!__�Q��,��"�-------- No. of compartments-----.Z--- Size- X�-f,- -_ Liquid clepth...... .___._Capacity--- - -- p .10-.--_---Distance to nearest lot line_-- _--._-- - pis asal Feld: Distance from nearest well...��---.-Distance from founds ion_-_ IIS J Number of lines.___-------------- ----- --Length of each line__'.&_,S7__ 5 Width of trench---- � "' j f i �-----�--jj ---- yp p of filter material-= - ----------Total length--1--------------- _- T_ ---- ` Seepage Pit: Distance ftloenear striwlell_..��--_D stance from foundation--------------------Distance to nearest lot line--.----.-------.- ❑ Number of pits----------------------Lining materia.l-----------;-----------Siz4: Diameter-----------------------Depth-----------------•--------------- �l ~ , _ --- .,� -------------•---- Cesspool: Distance from nearest well-__.---__---.- Distance from foundation---------------- Lining material-_._-______._�__-__ ❑ ;Size: Diameter--_-_-�'--- -------------- - - --- Depth------ _-`_-------------------------..Liquid Capacity----------------------------gals. m Privy: j Distance from nearestwell------------------ ------------------ ---------Distance from nearest building.--.-...------..----.--------------------- ❑ Distance to nearest lot line -�------------------------------ ----------------------- -------------- ----- - -------- Remodelingand/or repairing (describe)--------------------5--------------------------------------------------------------------------- ------------------------------------------------------- s ----------- ------------------------ -------= -------------------- -------------------------------------------------------------------------------------------------- ------------------------------ ------------------------------------- ---- ----------------------------------------------------------------------------------------------------------------------------------- I hereby certify that 1 have prepared this ip-plication and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)---- ��--------------�.----- -- �i ------- - - ------- ----- --- -------- -- - ---------------------- ---(O and/or o� r) weer an r Contract BY ' (Title)----- ----------- ---------- --------------------------------- ------------- - - ----------- ----- -------------------------- (Plot plan�,_showing size of lot, location of syste n relation to wells, buildings, etc., can be placed on reverse side). t FOR DEPARTMENT USE ONLY77 € APPLICATION ACCEPTED BY-- '------------------------------ -------------------------------------- DATE---------10-------- REVIEWED ----REVIEWED BY-------------------------- --------- ----------------------------- ---------------------------------------------------------- DATE----------------- ----------- ----------------------------- BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------------------------- ------ ------------------------- Alteration's and/or recommendations-------------- ------- -- --------------------------- ------------------------------------------------------------------------------------- -•--------------=--------------- ----------------------------------------------- ------------------------------------•----------------------------------------------------- ------•-------------------- --------------- --------- ( ----------------------------- ••- ---------------------------------------------------------------------------------------------------------------------------------------------------------- --------- I \i ` FINAL fNSPEC BY: :. Date--- ---------{� ' -------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 S.Hasellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California f