19661 - Laserfiche WebLink

Home Browse Search

IUK UFFICE USE. - -lQ-.--�'(-- 4r a to ----------- i --------------- ------------ ----- --------- APPLICATION FOR SANITATION PERMIT Permit No. ../__.� -------------------------------------------------------- (Complete in Duplicafe) _ -- -- ------- This Permit Ex ices 1 Year From Date Issued / Date Issued .��/-`S_-------- 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. I JOB ADDRESS ANP LOCATION,.-k1,_Q_7_ - - - ------ - - ------------------------------------ ----------------- wner's Name_.__ ------------------------- ' l ------- ---------------------------- Address ----- ----- ----- Phone-- _ - Contractor's Name..---_ 0---7--n --•----- ---------•------ _______ ---- ------- ----- --------------- Phone.---------•-------• ----- Installation will serve: Residencep A artment House (] Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of livingunits: -- L---- Number of bedrooms ---� Number of baths --- Lot size _07211_�qp ' Water Supply: Public system � ------�- pPY y Community system ❑ Private ❑ Depth to Water Table _¢zlft. Character of soil to a depth of 3 feet: Sand 0 Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay Adobe❑ Hardpan (j Previous Application Made: (If yes,date---------- --------_} No Ill New Construction: Yes Er 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 nearest well_ --__-_ Distance from foundation.../dNo, of compartments---_.Z--- Size ' c �� --- --- --------- ----- quept ----- ` . j -- g Capacity Disposal Field: Distance from nearest well.-.. -------Distance from foundation-#69 -`-----.--_Distance to nearest lot line_:-�"_'__--- Number of lines------/--_-_--_ ---- Length of each line_gQ_`__---- _-_-- 7 Type of filter mate t� Depth6 Width of trench_og- --•----- - 1-aL�--....__ of filter material-_fg----------------Total length-------jpa- -------------------__ Seepage Pit: Distance to nearest wall_,-.�--_ __Distance from foundation_AD__�--___ rn k _- Distance to nearest loft line_.-s___I-__-- Number of pits-----. ____---- ---Lining materia?a_G/.I'--_ Size: Diameter-_-_- , t33`'-- ----Depth-zr----------------- Cesspool: Distance from nearest wen-----------------Distance from foundation--------------------Lining material------------------- nQ Size: Diameter----------------- --- ------ -------- Depth-------------- ----------------- ------ v - ----- ---Liquid Capacity-_ --------- -------gals. Privy: Distance from nearest well__..__-_-.--_____----____❑ Distance from nearest buildin g Distance to nearest lot line__ -- Remodeling and/or repairing {describe)----------------- - ------------------- ------------------------------------------------ ------ --------------------------- ------------------------------- ------------------------•-------------------------------------------------------------- --------------------------------------------------------------- t 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County f ordinances, State laws and rules d regul tions of the San Joaquin Local Health District, I! (signed} ----------- ---- ---------- - ---- ------------------------------ ------------------------- -----------------------------------------(Owner and/or Contractor) By----------------- --------- •- - ---•• - - Title - -- - - ------ ------------------ ---------------------------------------------------------- - - i (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .---_ � ------------------------------------- DATE-_.10-7C REVIEWED BY----------------------------------- ...................... .......................... . ----------------------------------------- DATE ------------------- UILDING PERMIT ISSUED ___ - E' ---- ------------ - -------------------------------------- DAZE----------------- �------ ----- - ---------------------------------------- Alterations and/or recommendations: _ ------------------- ------------- ------------------------ ------- ------------------------- FINAL INSPEC.TIOI I BY:- ---- ----- r� �� Date-- ---- ----------- SAN JOA UIN LOCAL HEALTH DISTRICT 1601 E.Harellon Ave. 300 West Oak Sire t 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca, California Tracy,California F.P.a o.