20453 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: l - . .. ----------------------------- APPLICATION POR5SANITATION PERMIT Permit No. ------ ------------------ --- -- (Complete in Duplicate) - ------ ----------" This Permit Expires 1 Year From Date Issued Date Issued _ /g 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. S49. JOB ADDRESS AND`LOCATION----- c �----- -------r .�--- EI t ff p ------ Owner's Name -- ------ ---- Phone"___L _�_lr --I__ _._ Address---------------------- -4 -S. Contractor's Name ---------------------I-------- Phone---------------------------------- Installation will serve: Residence `Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _1-._-__ Number of bedrooms __Q_ Number of baths __1----- Lot size -------w?�_xL�----------------------------- Water Supply: Public system -Community system ❑ Private ❑ Depth to Water Table _t�Q ft. Character of soil to a depth of 3 feet: Sand p ravel ❑ Sandy Loam ❑ Clay Loam ❑ Gay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date--------."_ --------) No [ 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 nearest well--- -- D.) ____-----Distance from foundation____ _ .__..,Material---- .-.-"---__----.-_ -- Size ` Li Liquid de th - .F No. of compartments--------- ------ _Capacity----�----------- Disposal Field: Distance from nearest well----------------.-Distance from foundation-----10---------.Distance to nearest lot line____35-7____.. Number of lines-----------� �c- �------_-Length of each line----------- of trench------- Roc�G p ------------Depth length__."_"_____ ---------------------- `- Seep e Pit: Distance to nearest w`elf_.____—----------Distance from foundation_-__-_1O------"_.Distance to nearest lot line_-..tom"_ V Number of pits.-------f-.----------Lining material__"--_-------Size: r >x. _+--_----Depth____--6�-_---------- ______ +, Cesspool: distance from nearest well_________________Distance from foundation---------- ----__...Lining material-------------------.--____.-____.__. ❑ Size: Diameter-------------------------------------Depth--------- -----------------------------------------Liquid Capacity--- ------------------------gals. Privy: Distance from nearest well--- ------------------------------_-------_------Distance from nearest building------------------------------------------ 1 ❑ Distance to nearest lot line-. --------`- �I Remodeling and/or repairing (describe_________________ ------------ -------------------- ------------------------------- --------------------------------------------•--------------- hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County l ordinances, State laws, and rules and. regulations of the San Joaquin Local Health District. (Si ned g )------------------------------------- ------------------ --------------- ------ --------- ----- ----------------- - - ----------------- - -.(Owner and/or Contractor) By:------ ------------------•----------------------•------------- ----------------------------------------------------------- --------(Title)------ ---------------- - ----- -------- ---------- (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 42 APPLICATION ACCEPTED B �'-- --- -----1--------------- - ------------------- ---------------- DATE -/s�6� - ..................................... - - -- ----------------------------------- REVIEWED BY - DATE ----------------------------------------------------------- BUILDING PERMIT ISSUED------------------ DATE - --------- - Alterations and/or recommendations:___"__ _. , ------------------------------------ ------------------------------------------ -------------------- ---------- - --------------------- ----------- - i FINAL INSPECTION B ................. --------_. r5^��' 6 --------------- ----------- Date------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Slocklon,California Lodi, California Manteca, California Tracy,California F.p.C C.