21646 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: -------------------- ------------------------------------ ,�,AW --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. - �__°'7�... - ------------------ ---------------------- - -- -------- (Complete in Duplicate) Date Issued _-----------------------------------------------........ This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install th work hereiif described, This application is made in co plia ce with County Ordinance No. 549. JOBADDRESS S ANRkLCATION =Owner's Name--------- - --1---- ------ ---- ---------- ---------------------------------------------- Phone-- `�- �•-----Address---------�P . --------------------------- - -- -A`-�---------- { Contractor's Name----------------------- ---------------------•-- ------ Phone---------._-_------------------- Installation will serve: Residence X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel y❑r- Other EI Number of living units: __j----- Number of bedrooms —3-- Number of baths _rYLot size __.4�_._X---:KT----------------------- Water Supply: Public system VT Community system ❑ Private ❑ Depth to Water Table -------- ft. y Character-of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeX Hardpan 1!4 it Previous Application Made: {If yes,date_______--------------) Nb New Construction: YeeZ No ❑ FHA/VA: Yes ❑ No)�l TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public s1wer is available within 200 feet.) Septic Tank: Distance from nearest well____��----Distance from foundation-----IP-r_..M��rial_.rj____________________________�—_____. No. of compartments _Li Liquid de th__._-___ ..._�___-___..Ca acit f �-- p q R p y----- - -- -- Disposa Field: Distance from nearest well...,!0_._----Distance from foundation -.-____ Distance to nearest lot line_________________ r Number of lines------- _________Length of each line________ __ _____________Width of trench.-_ ___.. .-______. --- ---- _ r Type of filter material__a_�f�4�ck_Depth of filter material_._..__E_V----------Total length------- ____________ { ee a e Pit: Qistance to nearest well_____ __ ._..___Distance from foundation____/l3---______.Distance to nearest lot line_- _�� ___ Number of pits......------____Lining materia ---Size: Diameter__-_.-:3.,?_-r_------Depth-------.4-1ola 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-------------------------------.-...____-. ❑ Distance-to'-r+darest lot line- - -------------------------------------------------------------------------- ---------------------------- ----------------------- ------- , Remodelingand/or repairing (describe)--------------------------------------------------------------------------_------------------------------------------------------------------------------ ----------------------------------------------- ----------------------------------------- ---------------------------------------------------- ------------------------------------------------------------- -- ---- --------------------------------------- ----- -------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------- ---- --------------------------- --------------------------------------------------------------•-----------------------------------------------------------------------------------.------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State aws, and rules and egulations of the San J aquin Local Health District. (Signed -------------------- ------------------------------------------------(Owner and/or Contractor) By:------------ ------ -------------------------------- -----------------------------------------------------(Title)---------- -- ------------------------- .--- - --- --------- (Plot plan, showing size of t, location of system in relation to wells, buildings, etc., can be placed on reverse side). FORD PARTMENT USE ONLY APPLICATION ACCEPTED BY--------.. _ LDTE-----------3 6 C - REVIEWEDBY------------------------------ ------ ----- ----------- -------------- -------------- DATE------- ----------------------------•----------------------- BUILDINGPERMIT ISSUED---------------------------------- ----------------------------------------------------- ----- ------ DATE---------------------------------------------------------- Alterations and/or recommendations:----- - ----------------------------- ----- - - - ----------------------------------------------------------------------- ----------------------------------------------------------------------------- ------/ - - ------------------- - - - ----------------------- ----------- --------------------- ------- --------------------------- ------------------- ----------------------------------- ----------_-------------------- -- FINAL INSPECTION $Y:. Date ` JQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California i