18308 - Laserfiche WebLink

Home Browse Search

F � FFICE'US = No ..a ------- ----- --- APPLICATI0-4- FO--- ---- --- ----- -----„�--- - �� R SANITATION PERMIT Permit------ . -- y_---- '-_ - _____. -------------- IM, (Cornplete:in Duplicate) Date Issued ----------------- --------------------------- This Permit Expires 1 Year From Date Issue 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 incompliance with Couaty Ordin ce No. 549. fox 577 JOB ADDRESS AND LOCATION. I ------ `UIQ I lJ_�. / /_ - ----------- Ph ne Owner's Name_________. __ . � � - a I I .... Ad d ress------------------- "....... / �.5' /.� ', l'r1 -------------------.----•- ---------------------- Phone. _�l�'4 Contractor's' Name. ----------- ��-- - a,�/��,.------ ------------ ---------- ------------ •---------- -- Installation will serve: Relsidence,� Apartment House:❑ Commercial ❑ Trailer Court-0. Motel ❑ Other [:1 r Number of living Its: ---I.- Number of bedrooms ___;L7 Number of baths ________ Lot size __-_.__. -._ ___ Water Supply: Public system ❑ Community system ❑ Private;M Depth to Water Table -- +- Character. of soil to a de A of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay E] Adobe ❑ Hardpan ❑ r Previous Application Made: (If yes,dote...........:...__..) No I1 New Construction: Yes ❑ N6 FHA/VA: Yes ❑ Nom IIS, �� VN TYPE OF INSTALLATION AND SPECIFICATIONS: (No.septic tank orcesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well________________Distance from foundation_____-.___-__-___.Material-__.--.-___-___----_________.__----._____----. ❑ �, 1i p ------:�;�------------Liquid depth--------=-- - ------ Capacity. Dis osal Field: Distance,from nearest well.-�r�-_--Distanc � No. of compartments _ _____ ize______ 'il p e from foundation__/�---------Distance to nearest lot lina_�� -.----_ Number of lines------------ -----------Length of each line___ ,, __� .---__--.Width of trench._.- j----- --------- Type of filter material____ : Depth of filter material... ----Total length--------,/1Q-------------------_ Seepage Pit: Distance to nearest well Distance from foundation------------------- to nearest lot line--------------_. ❑ Number of pits------- ------------Lining material------ --------=---Size: Diameter-------- i Depth Cesspool: Distance from nearest well----------------- from foundation_.--------.---------Lining material------------------------------------- El Size::Diameter----- ---------- -------------------Depth-------=--------------------------- -- -------- Liquid Capacity gals. _________________________________ r Privy: Distance from nearest well___-.._._____--y_____________.-----_ ___-.._.__Distance from nearest building_, ❑ _ Disfa ce to nearest lot line.--- ----- � - -------- ------ ----------- -------------------- ----------------- Remodeling and/or rep �iring (describe) ___/ -.- , __________________________________________________Jv.�. __� •------------------------------------ -- - - ___________________________________________________ _ Il1 I hereby certify they I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State la and rules and regulations of the San Joaquin Local Health District. •lam �' _`-_{____ `r� --- (Signed) _(Ow rand/or Contractor)---- ------------------------------ ----------- By:--------- ��------------------------------------------------ (Plot plan, showing size 0f lot, lo ion of system in relation to wells, buildings, etc., can be placed on reverse side). �I FOR DEPARTMENT USE ONLY --------------- APPLICATION ACCEPEp BY--____ ___.__-___- -�--- _ -- = DATE-- _ REVIEWED BY =I( ---------- DATE BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE----------- ------------------------------------------------- i Alterations and/or recommendations:_.------------------------------------------------------------------------------------------------------------------------------------------ ----------------- I1.I ------------------------------------------------------------------ -------------- ---------------------------------------------------------------------------------------- IN; ------------------- - ---------------------------- ------------ ------------------------------------------------------- ------------------ - -------------------------------- - FINAL INSPECTION BY: Date j `J SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazolton'Ava. r 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,Callfoilnia Lodi,California Manteca,California Tracy,California