18437 - Laserfiche WebLink

Home Browse Search

I R OFFICE USE: ---------------- 3 ------------------------- ------------- - - --- APPLICATION FOR SANITATION PERMIT Permit No. -404— ..- --------------------------------------------------------- (Complete in Duplicate) y This Permit Expires 1 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 a plication.ris made.incompliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION______ ___________--_---- - +- ------___ _- 7 yyCC � p //yy / ------------------------------------------------------- Owner's Name---.. '�+ d_-G '0 ------ L- - -------------- Phone--------- Address--------- ---------------------------------------------• -- --------------------------- •--------------------- Contractor's Name-- -�- ---� �U --------------------------------- Phone Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __I____ Number of bedrooms __2_ Number of baths ___1___ Lot size __________________ Water Supply: Public system Fk---C'ommunity system ❑ Private ❑ Depth to Water Table JV ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sa dy Loam E] Clay Loam ❑ Clay ❑ Adobe [�erdpan ❑ Previous Application Made: (if yes,date....................) No PNew Construction: Yes Fr No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Ir Septic Ta k: Distance from nearest well-_'_--------Distance from foundationy-4-------------Material-.: ___ ______..._ ------------ pE No. of compartments-- ------------------ ----depth---- ---.---_....___.._Capacity- Disposal Field: Distance from nearest weli___._ Distance from foundation-_/a. ----------Distance to nearest lot line-1j"',--- � Number of lines------ ------- ----- Length of each ------------------.Width of trench-_ g-"------------------._- ^� Type of filter material C.--—.._____Depth of filter materiai___1A_�_____..___-Total leng#h__. P_`____________________________. � Seepage Pit: Distance to nearest well____._"...__-____Distanc4rom founda#ion__�P_r---------Distance to nearest lot line--%y------ Vill Number of pits------I--------------Lining material_C`---(-_ ._4_I(------Size: Diameter----3_.3_-------Depth------+ J---/- Cesspool: Distance from nearest weiC________________Distance from foundation---------------.----Lining material------------------_.____.____________. 3 ❑ Size: Diameter------ -- --------------- -----------Depth-------- ------------------------------------------ Liquid Capacity-------------------- gals. Privy: Distance from nearest well ____________________________-------------------Distance from nearest building------------------------------------------ 0 .________._ _____________..___._--._.❑ Distance to nearest lot line- - - ------------------------------------- ------------------------------------------------ ----------------------------------------------- 6- Remodeling and/or repairing (describe):------------------------------- -------------------•----------------------------------------------------------------•-•------------------------------ ---••-----------------------------------------------------------------------=-- --------------------•-------------------------------------------------------------------•-------------------- ----------------------4,r ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------- ( ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---- --------- 1 hereby certify that I have prepared this application and that 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. (Signed) ------------- ------------------------------------------------ ---- --------(Owner and/or Contractork7 By:------------��----- ---------------------------------------- ----------------------------- (Title) (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -- `-- -'15 .........•-•---------------------------------------------- DATE---2 --=3f 4-4 - -- -- ----- REVIEWEDBY----------------------------------------- ------------------------------------------- ---------- ----------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------ --- ---- DATE.- ----------------------- -- ------------------------------ Alterations and/or recommendations:_s� L- L- - ------------------------•------------- .....---------- ------------- -----------------•----------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------- --------------------=---------------------------------------------------------------------------•--------------------------------- - ------------------------- -------------------------- -------------------------------------------- I ------ - ----------------•-------------------- ----------------------------------------------------- FINAL INSPECTION BY:.f _..P.--4-- - ------------------- Date----4.-1--------� �5 SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stocklon,California Lodi,California Manteca,California Tracy,California 4 ! F.P.0 O. �F