18166 - Laserfiche WebLink

Home Browse Search

— - �� ---------- �'p o - ... --- - ------ ----- ---- ---- ------- _' _ __._ APPLICATION FOR SANITATION PERMIT Permit NoY...---- --- (Complete in Duplicate) / This Permit Ex fires 1 Year From Date Issued Date Issued ___--ft/ l y Application is hereby made to the San Joaquin Local Health Dist ricf for a permit to construct and install the work herein described. This application is made in compliarice with County Ordinance No. 549. JOB ADDRESS AND LOCATION_'-34-3---G---- f/� i -- ------------------------------------------------------------ ----------------•------- 1:0 Owner's Name___ _ � ---------•------------ -•----- ------------ -------------- -------- Phone Address-----••-------------_----- Contractor's Name_____________ � ------- ------------------- Phone..--•-------- -------------------- ❑ ❑ Other -------------- - Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court Motel ❑ f Number of living units: ---If---- Number'of bedrooms _. _ Number of baths __ ____ Lot sizeF. __ ____ :- Water Supply: Public system [T-Community system ❑ Private ❑ Depth to Water Table -4k-4. Character of soil to a depth of 3 f4f: Sand ❑.,Gravel [:] Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe &-hardpan ❑ Previous Application Made: {If yes,date-------- ...... } No [Z}�New Construction: Yes ❑• NoFi IA/VA: Yes ❑ No �f TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permiffed if public sewer is available within 200 feet.) Seank Distance from nearest well-______________-Distance from foundation__.____-____.__....Material-_____.__________..._____ No. of compartments------ -------------- ----Size------------------ Liquid depth - Capacity Disp I�Fi Distance from nearest well_________________Distance from4cundation-------------------.Distance to nearest lot line___._______-____ Number of lines_----------- ------Length of each line------------------------`-----Width of trench----------------•-------_--- Type of filter material-------------------------Depth of filter material-----------------:-----Total length------------------------------------____-- un See age •+t: Distance to nearest well--- -------------- f m foundationDJ t tri ----------Distance to nearest lot line_______ ________ W Number of pits..___-f_____________Lining mafieriaL___-� __"- ..Size: Diameter__.___ a 3 -i----Depth....... -(�S- 0 Cesspool: Distance from nearest well-----------------Distance from foundation__________________Lining material-._--_._....__.__---__._______- ------ ❑ Size: Diameter Depth --------------------------------------Li uid Ca act t ; - q p •tY-- ------ ------------ ---gals.M Privy: Distance from nearest well__________________________ ________________...._Distance from nearest buildin ❑ Distance to nearest lot line----------------------------------- - =s Remodeling and/or repairing (describe):--------------------------- -------------I------------ -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify fhaf 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 the San Joaquin Local Health District. Xi _ (Signed)----•------------ -'-JL - ----- ------ ------------- --------------------------------- ------------------------ -- - Contractor) By:-------------- Title ------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, efc., can be placed on reverse side). FOR DEPARTMENT USE ONLY / APPLICATION ACCEPTED BY-- ------- a'y ' ---------------- ------------- DATE-------- 11--10-.G ---------------------- ------------------ - ---------------------------------------- REVIEWED BY ------ ----- ------ DATE BUILDING PERMIT ISSUED_____________ _ I -------------------------------------------------------------------- -- DATE A! erations and/or re e atso s.: __ ---------------------------------------------------------------------- ---------- -------------------------------------- ------------------t--------- - ------------- ---------------------------------------------------------------------------- - ------------------- -- ---- _ FINAL INSPECTION BY:--- - C- [ '. Date `�-�� _&I,SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F,p,Ca.