19093 - Laserfiche WebLink

Home Browse Search

----------------------------------------- ---------------- APPLICATION FOR SANITATION PERMIT Permit No. --------- --------------------------------- ----------- (Complete in Duplicate) ' This Permit Ex fres 1 Year From Date Issued Dat�issued - Application .is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the workherein described. rd. This application is made in compliance with County Or 'Hance No. 549. ` k JOB ADDRESS AND LOCATION__i �'s��•c�P��/ " - a` ---------------------- Owner s Name____C"'I4�'_v n' v� Q pEiS / Phone ------------------------------- Address------- 0`� , Es . , Contractor's Name----------------------- it4 l �/------�� ---------------------••----------- Installation will serve: Residence ❑ ' Apartment House Commercial B___Tlailer Court ❑ Motel ❑ Other ❑ Number of living units: __-©_ umber of bedrooms _ -- Number of baths --y Lot size __- .___ ---- ---- ----------------------------------- Wafer Supply: Public system Community system [-IPrivate ElDepth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam lay ❑ Adobe ❑ Hardpan © t Previous Application Made: (if yes,date.-------_-----------) No B--New Construction: Yes ❑ No FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS- (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nelarest well----- _--Distance from foundation__,< _--__-._-Materia!__ LAS No. of compartrients-------- ---------._.Size__��-�_-�----Liquid depth__-�9r_'r---- >rq _ ___Capac,tyf,�cs�,p-___-----1 Disposal Field: Distance from nearest wel1__.._1'_ ..-Distance from foundation_ .�_>_ __.__Distance to nearest lot line_ ©- Number of Lines__ - ----- ------- -------------Length of each line ---Width of trench._}`Type of of filter material---�4.6 <-----Depth of filter material/ K-_ Total length- /10--•--- ---------------- ' Seepag Pit: Distance to near st'well____ 11 --------------- fr foundation_ _____.Distance to nearest lotrQ_-•� Number of pits..-�.2- ----------Lining material__ --.Size: Diameter_____3S -----Depth_.�:5 -------------- Cesspool: Distance from n arest well-----------------Distance from foundation---___-.__.___.___,Lining material-___-----__________---_-.___-_ N Vt Size: Diameter-----�----- ----------- --- ----Depth------- ------------------------------------------- ILiquid Capacity---------------------------gals. „� Privy- Distance from nearest well-___------------------------------- ---- ----Distance from nearest building - ---------- --------------------- ----------------------- ------ Distance to nearest lot lire-_____-_...__________________ ----------------------------------- Remodeling and/or repairing (describe)_ L %1>- - ----- ------------------------------------------ -------- ----------------- -•----------------------------------------- ---•-------- 111 -- -------------- --------------------------- ----------=----------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, SSW and rules and'regulations of the San Joaquin Local Health District, (Signed)-------------- - --- j _1 A�of � / er and/or Contractor) -- -------------------------------------------------------------- BY:---- --- -- -------------- -� --- (Title)---- - ----- ------------ --- ------- ------------ --------- -- -- -- (Plot plan, showing size of lot, io antem in relation to wells, buildings, etc., can be placed on reverse side). I t t ( FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY..... pATE____ � REVIEWED BY----- ----------------------------- ---- ------------------------------------------------ DATE------------ ----------------------------------------- --------UILDING PERMIT ISSUED---•--------------`--- ----- ----- ----------- --- --- - ----- DATE----- Alterations and/or recommendations:_--G_..�_�_.5__. I ------------------------------- ----------- --------------------------------- -------------------------------------------- -- - ------------------------------------ I -------------------- -------------- --------------------------------------- ------------- ----- --------------------------- ------------------------------------- ----- - ----------------------------------------- FINAL INSPECTION BY:---- .. - Date --- ------- ------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stocktan,California Lodi,California Manteca,California Tracy, California F,P.CO.