19955 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. ------------------------------------------------ f-� -------------------------------------`--------------- -- (Complete in Duplicate) ----- -- , This Permit Expires 1 Year From Date Issued Date Issued ls -`-_�-. � 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 Ordi nce No, 549. JOB ADDRESS AND LOCATION..-- 3 ------- ------- -------------- Owner's Name--— - -- - --- ---• ---- ---A----------------- Phone I�z-....._- -----------------• ----------- --------------- -----•--------------------..-..-..---_----•--- Address---------- ---- ---• •- -----• ---- --------------------------------------------- Contractor's Name--- _-- -.--1_- ---- Phone----------------------------------- Installation -------------------------Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Mofel ❑ Other ❑ Number of living units-.'-: Number oof bedrooms ---3- Number of baths I---- Lot size �---------------_-..--_._..____.-_ Water Supply: Public system ZT__�C_ommunity system ❑ Private ❑ Depth to Water Table l, ft. Character of soil to a depth of 3 feet: Sand E] Gravel El Sandy Loamk�ay Loam ❑ Clay E] Adobe ❑ Hardpan ❑ ¢ Previous Application Made: If yes,dote-.2^�'��1 avNo ❑ New Construction: Yes ❑ No,gj-- FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic k: Distance from nearest well-----------------Distance from foundation--------------------Material---..---.---.-----.------_-----------.--___-----. IjNo. of compartments--------------------------Size-------------------------------Liquid depth--------------------------Capacity----------------------- Dispos Field- iDistance from nearest well__:--_-___ ___Distance from foundation-/O ----------Distance to nearest lot line-15. 41 :Number of lines-----��-- ------------------------Length of each line___.-_ _c -----.---.--.Width of trench_--. -. -- Type of filter material-- __-Depth of filter material--/�_-----------Total length..-�'p___`_-------------__-------._- 4 Seepage Pit: Distance to nearest well___.__"`-_.--------Distance from foundation-/b---- Distance to nearest lot line.!7F74'-._--- Linin material____ � _ Size: Diameter____- - Number of pits-'`--�--- --:------ g �-14" / --Size: 3„� ---- ----Depth--- �Z,5 ------ -----• Cesspool: Distance from nearest well------___ Distance from foundation ---.-..Lining material------------------------------------- t�I El Size. Diameter------ --------------------------k-bepth----------------------------------------------------Liquid Capacity---------------------------- gals. Priv Distance from nearest weIL-_-......--�-�-.-------- _..Distance from nearest`6uildin ❑ Distance to nearest lot line....--.------IN----------------------------- -------- -= = ---- ------------------------------------------ Rem elin and/or repairing es }: ----- st4 ------ -- ---- ------tm --F---- -` - ------- W ---�� ` --`-- ----- ------ ^ --------- ----------- -u �-- r fa L c -- �• ---------- Z-- 1€, ' = I hereby certify that I have prepared this application and that the'work will be done in accordance with San Joaquin County ordinances, State laws, a d rules and regulations of the San Joaquin Local Health District. t (Signed) - {:_1^_'.----_-_ « ---------------Owner and/or Contractor Bw (Title}_ . ' ------ - -------------------------------- Y:--------••- ----- --=---- ------------------- ---- ' . (Plot plan, showing size of lot, location of system in. relation to wells, buildings, etc., can be placed on reverse side). r A ( FOR-DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ -- -- - ---- - ---- ` REVIEWEDBY--------------------------------------L------------ --------------' -------------------------------------------------- DATE--------------{-------------------------------------------- BUILDIjNG PERMIT ISSUED-------------- -----'---------------------------------------- ---- DATE------- ------------- -- _ Wit: Altera#'ons nd/or recomme afions:.- Q.>!, .-_you�(�_._.__ .__ _1 �� _ .______-( 71 -.-_- P2�..--- -_.--_. „2C1-fel/ .------ - - ------ L. �p . �� ;. ....... w----------------t----------------- _____. _�I-..__. ---------------------------------------______ FINAL INSPECTION BY:..te-..- --------------- Date-.. cam`--------- ------------ ------- ---------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hosellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California