18635 - Laserfiche WebLink

Home Browse Search

—FOR OFFICE USE: - --------- = --------- --------------- - ---- ` APPLICATION FOR SANITATION PERMIT Permit No. __.------_. (Complete in Duplicate) 3f ----------------- --------------- ------------------------- 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 her enribed This application is made in compliance'with County Qac i lance I�. 54,94 L t/�� c/lGy � WA je" JOB ADDRESS AND CATI0 � > Ij --_--- Owner's Name ------ ---------------------- Phone----------------- ------•--- ----- I -------------------••�------•---•---------------•------- Address----- ------------ ----------------------------•------------------•- Con#ractor's Name- -U" ----------------------------------- -------------------------------- -----.._._. Phone.. Installation will serve: Residence Z<Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of linin units: _ __ Number of bedrooms Number of baths -�-- Lot size __,,& ��- •- ------------------------------------ g / �--- -- Water Supply: Public system ❑ Community system ❑ Private &16epth to Water Table 1A"ft. Character of soil to a depth of 3 feefT Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No J2-'New Construction: Yes jgj�'No ❑ FHA/VA: Yes *-"No ❑ rt TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public ;ewer is available within 200 feet.) f r Septic Tank: Distance from nearest well___A__ ____Distance from fj ndatio ----l+ _.__._Materia4_ __�+a__- "f` ----------- No. of compartments..,?...................SizeJj0_5W quid depth___'!-__.._.___---Capacity//( ----- '� Disposal Field;. Distance from nearest well..9� _Distance from foundatio`"Z� ...__ Distance to nearest lot line_�W-__._...- (3t GLd' ! Number of lines-- ------ _ Length of each lineff -��kV' - hdth of trench- ____,._�______________________ Type of filter material 1 /_Depth of filter material_ -------- otal length-_.r D'________-______________ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line____--:.___.--'._ ❑ Number of pits---------------------Lining material-----------------------Size: Diameter-----------------------Depth------------ -------------------- .i.,, Cesspool: Distance from rearest_ well________________ Distance from foundation---------------------Lining materia -------------------- ❑ Size: Diameter__- ----- 4--------- ---Depth----------------------------------------------------Liquid Capacity----------------------------gals. �+ ----------- Privy: Distance from nearest well-__-..--_.__--._-------------------------------Distance from nearest building-----------___._--_._______------------- ❑ e----- - - ------------------ --------------------------- Distance to nearest o in + 14, Remodeling and/or repairing (describe):---------?ke*l - ---------------------------------------------------------------------- - - --------------------------------------------------------------M1 ---------. ---------------------------------------------------• ---------------------- ---•------------------- --------------- ------------------------------- --------------------r hereb certif + st I have r--pared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulationsf the San Joaquin Local Health District. (Signed) `` ------ --- ---------- - ( Contractor) . By:------------------------------- ------------ ' --------------------------- {Title) - - (PlotIan, showing size of lot, Iota+ion of sys+em in rel n to wells, buildings, etc., can be placed on revers e). ( o+ P r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- - -------------------------------- DATE------------------------------------------ ----------------- REVIEWEDBY---------------------------------------- ----- --------------------------------- DATE------------------------ ----------------------•------------ BUILDINGPERMIT ISSUED-------------- ----- ------ DATE------------------------------------------- -- -------------- Alterations and/or recommendations-------- -------------------- - ---------------------------------------•-------------------------------------------------------- ------------------------ - ---- ------"---------------------------------------------------------------------- E -------------------------------------------- ---------------------- ------------------------------ ------------------------------- --- ------ ----- si i FINAL INSPECTION BY: Date-------------- ------ -- ------------- - -�----------------- ----------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:ellon Ave. * T 300 west oak street 124 Sycamore Street 205 West 9Th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CG.