19110 - Laserfiche WebLink

Home Browse Search

'FOROFFICE USE: _________________ APPLICATION FOR SANITATION PERMIT Permit No. ----------- ----- - ------------- (Complete in Duplicate) Date Issued --- - --- - 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. "K—P JOB ADDRESS AND LOCATION......SII/ Owner's Name------------------- f F------- _oobw_ 1--?v----•--•--------------------------- --------- --- Phone--------------------- ---- Address !T_ ! C -`--------------------------------------------------------------------------- ------ ----..1 T-- Con#ractor's Name_ 5a + 1 1Cl�t -- RI C Z ----- Phone....----•-...---•-•-••--•--------- Installation will serve: Residence ❑ Apartment House ❑ Commercial railer Court Motel ❑ Other ❑ Number of --units: -2-- Number of bedrooms -------- Number of baths -z-- Lot size -----l-- C ---------------------------------_ Water Supply: Public system ❑ Community system ❑ Private �Depfh to Water Table !-2 ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (if yes,date------------_----.-) No New Construction: Yes FHA/VA: Yes ❑ Nof[ --j 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_ 0------Distance from foundation----I-1 �,! ---- -- ----------Material ---�'j�-------pf=, No. of compartments--- 2--_.-_.__Size-)'-_ /a-X�_Liquid depth_-�-?�.-.---------Capacity...22jea: Disposal Field: Distance from nearest well___ ......Distance from founclation-A49- ---.--.Distance to nearest lot line---- .� i e I u Number of lines---------------- ------------------Length of each line----- --��-------��----Width of trench.-----=��-- ?,------------- Type of filter material---/RO.CX_.---Depth of filter material-_---- /,----------Total length-------11674 --_------------------- Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line-.-----.------.-- 3 '. ❑ Number of pits----------------------Lining material----_---------------.Size: Diameter---------_-----------Depth--------------------------------- C� Cesspool: D) stance from nearest well----------------- from foundation--------------------Lining material-------------------_----------------- ❑ Size: Diameter----------------- -------- ------ ----Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-----------------------------------------------..Distance from nearest building----.-----.-- -_-_--_-_-_-_------------ p i ❑ Distance to nearest lot line---------------------------------- ------------------------------------ -------------- ----- ----------------- - ---------------------------- ZOO Remodeling and/or repairing (describe):------ ------------------------------------------------------------------------------------------------------------------------------------------------ -------------------------------------••--------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------- ----------------------------------------------------------------------•--------------------------------•--•--------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------ --------------------------------i----------- ---------------------------------------------------------------------------------------------------------------- I hereby cert' hat I hav, prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat I s, and r s and gulatio of th San J aquin 4ocal Health District. t (Signed) - ----------------- ------------------------------(Owner and/or Contractor) By:.--- -------------------------------------------------------------(Title)-------------------------------- (Piot plan, s i wing"size of lot, locat' of system in relation to wells, buildings, etc.;-can be placed-on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------T 13'0------------- ----------- ---------------------------------------- DATE------ REVIEWEDBY--------------------------------------------- ---- ------ -------------------- ------------ --------------------------- DATE------------------------- --------------------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE---------------------------------------------------------- Alterations and/or recommendations:---------- ---------- ----------------i----------------------------------------------------------------------------------------------------- --------------------------------- = 2 _ -.-r-:_-7�a�t< -------4G54c+-L-----42,_!%c----------`_,V_12�:A-- 5;�eo►<ts---------rj9- - --------- ---------------------------------- ---------- ------------------------------------------------ ----------------------- ----------------•----------- --------•------------------------------------------------ ------------------------------------------------------------ -------------------------�-- ------------------------------------------------------------------------------------------------------------------ --------------------------------- ....... - ------- ------------------- ---------------------- ------- --------------------- ------------------------ FINAL INSPECTI ----- -- -- ---- -- Date % --��----------- --- ---- - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California i F.P.Q(3.