19029 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: -' --------------- ------------ APPLICATION APPLICATION FOR` SANITATION PERMIT Permit No. ..�-J_1�---°�_.! (Complete in Duplicate) J j� Date Issued lS ------------------ ----- This Permit Expires 1 Year From 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. 549. JOB ADDRESS AND LOCATION - 1= ��c--------------•---•--------------------•--------------------------------------------------- Owner's Name---------�------- ---•- ----- Phone----••----------------------••-•---- Addressv l(r Contractors Name ------ -----------•- --V-- ---.-' �--------- •------- •-------- --- Phone--- `r �z & Installation will serve: Residence E-- Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___/-_- Number of bedrooms _Z___ Number of baths _r----- Lot size ------ .l Water Supply: Public system-®` Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe a Hardpan ❑ Previous Application Made:"'(If yes date.".'_:- �No New Constiu�tion:`Yes ❑�No FHA/VA: Yes [I No [�— :F l 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-_ffiq--------Distance from foundation----Za.........Material----/?:7 � _a.`� -------------- No. of compartments--------Z---------------Size---- -_-Liquid depth---_---Y-.'_--------------Capacity---d' -c�- Disposal Field: Distancefrom nearest well----4&......Distance from foundation----/_a...........Distance to nearest lot iine__ _---_---_- FF Number of lines------------t--------------------Length of each line---------9.9_------------..Width of trench-----Z--1--------_-_._______._--. V Type of filter material �� .F-_---_--_Depth of filter material----.1_ _.`_______.Total length------- ------------------------- 0 Seepage Pit: Distance'to nearest well-----& ---------Distance from foundation---__ Distance to nearest lot line..sr..._...... ®- Number of pits----------------------Lining Size: Diameter.--- Depth------At5-----------.-----_- ' r ;! Cesspool: Distanceffrom nearest well-----------------Distance from foundation_____._____.-_-_._..Lining material_______----.--.-.-_---__-._-------_-_ rn ❑ ize: Diameter--------------------------------------Depth----------------------------------------------------Liqui.d Capacity---------------------------gals. Privy: Distance':from n well-----...__----.---_-__-------------__.-__--.-Distance from nearest building------_.-------------------------- - C1 ��Distance'rto nearest jot line--- - ----------- ---------------------------------------- ----------------------- Remodeling and/or repairing (describe):---------------------------------------------------------------- --------------------- _--------------------------------------------------------------- ------------------------------------------------- ------ - ------ --------•-- �-- ---------------------------------------- "f i I ,--,, -------------------------------------- ------------------------------•--------------------------------------- -------•--------------------------------------------------------------------------------- -- ------------------------ ------------- ------------------•----- ----------------------------------------------------------------- -- 1 hereby certify that I have prepar-ed'fhis}applicatiori and-fl St-the work will be done in accordance with San Joaquin County ordinances, State laws' and rules and regulations of the San Joaquin Local Health District. Si ned '' I ( g )---------------- --�--Z--- . - -- -�----{ ---�-----�----------�----- -;:-, --.�.;-----�------------------------(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). i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ ------ -- ---------- ------- ---------------------- DATI=--- c`w -- - - REVIEWED BY------------- ---------=u ------- - _• ----- ---------------------- DATE BUILDING PERMIT ISSUED--iv ------- _ _-D-ATE_----------------------------------------------------:-`---.---------------- ~ Alterations and/or recommen,dations -.-__.---_ ----- ----------------------------------------------- ------ I ' ------------------------------------------'_._.._.._ .. FINAL INSPECTIONA BY:__A -------------------------------- - bate------G ---------------------------------------------- SAN ------------------------------ ------------SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxellon Ave ` 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California �l F.P.r- D. Il f