20578 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: _J, -------------------�/gam _.------------------:�._--------?117Q_------_ APPLICATION FOR SANITATION PERMIT Permit No. ----------------------------------- ?e- ---------- (Complete in Duplicate) i This Permit Expires i Year From Date Issued Date Issued ____= - 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. 5549. JOB ADDRESS AND LO ATION j ---� -------------G--Z------------- �i4�!- I ----, ------------------------------------ Owner's Name------------ 1,14='` - - -------------------- -- --------------------------------- Phone----------------------------------- Address ti -------•--- --- ------- - ••--- --- --------------------------------------•----•----------------------------------------------------------------------- -� --r Contractor's Name------------------------ ------ ----- ---- Installation will serve: Residence Q( .ApItrtment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ r - Number of living units: ---/_ Number of bedrooms ___f_ Number of baths --/-- Lot size -------_ Water Supply: Public system X Community system E] Private [IDepth to Water Tablee;_n�ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay [] AdobeX Hardpan ❑ Previous Application Made: (If yes,date-------_-----____.-_-) No New Construction: Yes ❑ No EK FHA/VA: Yes ❑ No ❑ { TYPE OF INSTALLATION AND-SPECIFICATIONS: (No septic tank or cesspool permitted if.public se er is available within 200 feet.) Septic Tank: Distance from nearest well-6-111- a from foundation------------------ Material-------------------- ------ - ❑ No. of compartments----- ------ - ----- �S ------- ------Liquid depth--- ------ ----- ---------Capacity----=-=---------------- +�ist -e from foundation____________________Distance to nearest lot line____________-_--- Disposal Field: Distance from nearest well- _ -.--._ T e of filter material.--------_---____...__De Depth of filter material-------------- ❑ Number of lines-----------------------------------Length of each line-----------------------------,Width of french---------------_..___._.._......._.- r� YP � � � P ---------Total length------------------------------------------ V' Seepage Pit: Distance to nearest well_-I_-�'_______._Distance from foundation__/Q_------,Distance to nearest lot line__�6------..._ W I Number of pits__. .. ------------- Lining materiaL_p+MO-Q' Size: Diameter_._ __r-.-____..___Dept h-----o7.,5 ..- ......... Cesspool: Distance l-__ __ ce from nearest wel ___ .-.__Distance from found ---------- __ ation.--__._. Lining material_ _________________________________ i ❑ Diameter------------------ -------------------Depth-= ;-----{-------------------------------Liquid Capacity-.--------------------------gals. -% I Privy: Distance from nearest well ______________________________-----------_______Distance from nearest building---------------________________._________- ❑ Distance to nearest-lo't,lire----------------------- ---------- - ------ - ------------------------------------ ------------------------------------------- - Remodelin and/or repairing describe -_.! �� 2y� g / P g ):---------- � .� l• -4 �! I' -----•-----•---••--------------------------------------------�-f'� 0----------------- -- ------------------------------------------------------------------------------------------------------------- - ------------------------------------------------------------------------ 1 ordinances. State laws, and rules and------------------------•----•------ ----------------------------•------------------------------------------- ----- ----- --------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County regulations of the San Joaquin Local Health District, f (Signed)------------------------------------------------/-- ------- - (Owner and/or Contractor) B ---- `�`` -------�3�----- -- Title r -- --- ---- ----•- (Plot plan, showing size of lot, loeatio taf system in relation-f,-o- wells, buildings, etc., can be placed on reverse side). r R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- -------------- ------------------------------------------- DATE----- REVIEWEDBY------------------------------------- ------------------------ --------------------------------------------- DATE-------------------------------------- BUILDING PERMIT ISSUED------------------ ------------------------------------------•- ------ DATE------ -- ------------------------- --------- -------------- Alterations and/or reco endations:---------- --------------- -------------------------------------•--•------•---------------------- r---------- P I/ ( = ! ---- . '--------- r ------------------------------- - ------------------------------------------------------------------0----------------------------------------------------- ------------------- ------------ -------------------- ------------------ -- ---------- ----------------------------------------•----------------•-------------------------------------------- ---------------------------------- --------------- - ------ FINAL INSPECTION BY:- ----?- ,(_` �� : Date-------- ---� , f SAN JOAQUIN LOCAL HEALTH DISTRICT 1 1801 E.Hazelton Ave, 300 West Oak Street 124 Sycamore Street 205 West 9t#,Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.o o.