12064 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT - Permit No. ._. U 5 (Complete in Duplicate) This Permit Expires 1 Year From Date Issued Date Issued ._-__/=_��1r�Ra Application is hereby made to the San Joaquin Local Health District for a permit to construct ,�in}�Wworki described. -This application is made in compliance with County Ordinance No. 549. �JOB ADDRESS AND LOCATI N + r /-`Owners Name ----- Phone---- fi;� I �1� — 'r{ } Address-- -} -------- ------ - - . ..-- -.._._ _ b = ------r---.o_n-e-`s. .. . : ". -------------- Contractor's -----------Contractor s Name--------- Installation will serve: Residence (Apartment House ❑ Commercial ❑� Trailer Court ❑ Motel ❑ Other ❑ Number of living unit: Number of bedrooms . Number of baths , _. Lot size Water Supply: Public system ❑ Community system ❑ Private Depth,to Water Table &4/oft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam E] Clay Loam E] Clay E] Adobe H�Hardpan ❑ Previous Application Made: Yes ❑ No ®' New Construction: Yes ❑5:No P' FHA/VA: Yes ❑ No Kr- TYPE OF INSTALLATION rAND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T nk: Distance from,nearest we I_ �Q__---_Distance rom foundation___ �-______.Materal�_GLf I �: 9 P ---4-----------Capacity...__ 4x Es, No. of compartments".-__ '_Size- __X1/1'--_.___L,Liquid de th____ ""_"_ .y F .; fs osai?iId: Distance from, nearest well. __� ._____Distance from foundationp �- - __�?1�-----_Distance to nearest lot line___1�..____ ____-----Len th,of each -lline. P/r�' � Number of lines.....�•'____-- g ��_"-- Width of trench__-- ---- ---f/--------------- Type of filter matena�2,'4�epth of filter material_: ._,1&P�y___-.Total length_____ s u� �---------- Seepage Pit: Distance to nearest well__ ��_ '__Distance fr m fo ndation__,_-- ._.___p"st �p to nearest lot Number of pits_t° . ."_________Lining material-f �l`c, _.5ize: Diameter- Depth---- ° _____________ Cesspool: Distance from r earesf well_________________Distance'from foundation--------------------Lining material-------------------------_-__._____- ❑ Size: Diameter--- ----------------------------------Depth_"-F__------------- _. Liquid Capacity ------------ 9 p tY gals. Privy: Distance from nearest'well-------------------------------------------------Distance from nearest building--------____________.___________..._._.. ❑ Distance to nearest lot line---------------------------------"_ i ----------------------------••- -------------------------- Remodeling -------- -------------- - ----------- f I E Remodeling and/or�rig (describe):---____-- :-- _ ---- - - ----�---- ...._.."-...._.. -•-- -- -- -------------•_------;-----------------F•--- ------------ ------------- ------------------------------------- ----------------- - - - --------- --------------------- --- I hereby certify that I have prepared this"application and that the work will be done in accordance with San Joaquin Count i ordinances, State'laws, and miles and regulations of the San Joaquin Local Health District. 5i ned � ( 9 )-------•------ -- - -- ------------- - - - --- - -------------- ----�- r Contractor) sY ------------------------- -------- -------------•- -- - ��---- - -----(Title)------ �.P��'-�.. I (Plot plan, showing size of lot, location of sy In,relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION.ACCEPTED BY----- r l ------------------------------------------------ DATE------- REVIEWEDBY------------------------------------------------------------ ---------------------------------------------------------------- DATE BUILDINGPERMIT ISSUED------------------------------------------ --•------------------------------------------ ------------- DATE Alterations and/or recommendations:-------------------------------------- -------- •-•-------------------•------------------------- --------------------- -------------- - - ------ ------------------------ - - --------- ".� '-� --------- - ------------------- ------------------------------------------------------------------------------------------------------- - --- -- ---- - -- FINAL INSPECTIONBY: C r Date---4- � —,I,�d SAN.JaAQUIN LOCAL HEALTH DISTRICT a } 130 South American Street 300 WeaV'A st�0freet '�,�,132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised V59 FP.Co.