20837 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: ----------------------------- ! f APPLICATION FOR SANITATION PERMIT Permit No. _ � ----------------------------------- ---- ---------------- (Complete in Duplicate) Date Issued - ----------------- - ------------------------------------- This Permit Expires ] 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. w , JOB ADDRESS AND ATION---•- -:--� --------------------------------------------------------------------------------------------------- Owner's Name----------- ---------- -. Phone------------------------------------ ---------------------------------------------------- - - Address-------------------- Contractor's Name----.-.--- ' I - •--•-------------------------•-------- Phone----------------------------------- Installation will serve: Residence 93,—Apartment House ❑ Commercial ❑ Trailer Court ❑f Motel F1Other ❑ "" Number of living units: -- - Number of bedrooms,,,?--- Number of baths--- Lot size/�--4F&/.'0---.------------------------------- 11 Water Supply: Public system D Community system ❑ Private �epth to Water fable -t�Q�. Character of soil to a depth of 3 fee Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loani❑ Clay ❑ Adobe I' ardpan ❑ Previous Application Made: (If yes,date--------------------1 No New Construction: Yes �o E] fHA/VA: Yes �+ No ❑ TYPE QF INSTALLATION AND SPECIFICATIONS: ,�k_. (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well -----Distancefr m foundation__1,9____....Mat�i�l_ _�� ------------- r [ No. of compartments------ ---..--..----Size_��--X__V0---_-_.Liquid dept----X;----..........Capacity_��&P_--_- r Disposal Field: Distance from nearest well...„~____Distance from foundatio�yn-_ovr......Distance to nearest lot line_Zr,P____. Number of lines-_ _______�-�..---.___ Length of each line.--.-X-i � - .Width of trench_ __ ___ ____________________ 9 + Type of filter material-- Depth of filter materiol-.4 -----------I ofal length- --------------------------- Seepage ---------------------`_.Seepage Pit: Disiance to nearest well.__,1_;Pe----Distance from fou datioh_.,-� _.---.Distance to nearest lot �. Number of pits-.-�_-----------Lining material__,_Y_C,,6-Size: Diameter. _--------Dept ha14�� cesspool: = .. _.... Distance from nearest well------------- Distance from foundation---.---II :-----..Lining material---------------.-.-.--_-------------. r Size: Diameter ` ---- ----De Dept -------- ---------------------- -Liquid uid Ca acit r ❑ 1 = ...,.. .. .. P q Capacity.... gals. -v. ,.. , Privy: Distance from nearest well---------------------------------------------_.-Distance from`;r earest building------------------.------.- ---_§_-----. .1d ❑ Distance to nearest lot line -- - ------- -- ----- ; s ---------------------------- ---- ------------ Remodelin andao�re repairing (describe): 1 P 9 ----------- -------- { 1 fA ------------------------- ------- { 3 - 4 i ' I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Count, ordinances, State laws, and rules jand regulations of the San_Joaquin Local Health District. -' .(Signed) r --------------------x-/47 .. �r Contractor) By=-------•----------------------------------- ----- r, ----------- -----(Title) s�� y� (Plot plan, showing size of-lot, location of system in ation"to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- ----------------- DATE--------------7 I _/_A= ------- --------- REVIEWEDBY------------------------------------------------------------- --- --- ---------------------------------------------. DATE---------------------------:------------------------------- BUILDING PERMIT ISSUED = DATE. �� s � �. Alterations and/or recommendations: .------rk-I----- -' A --------------------------------- - - ----------•------------------------------- ----------------------------- ----- - ---------------------- --•----------------------- -------------...----------------•--------------------------------------------------- f--.- FINAL INSPECTION BY:- -- -----.--------------- - ------•----- Date._.. ----• ....... ----- ------------------------•---- SAN JOAQUIN LOCAL HEALTH DISTRICT A rr 1601 E.Hazelton Ave. 300 West Oak street + 124 Sycamore'Street 205 West 9th Street j € Stockton,California , Lodi,California Manteca,California Tracy,California / F.P.0 O. !