20720 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: ------ -- ----- ------------------ ----------------- APPLICATION FOR SANITATION PERMIT Permit No. c ------------------- ---------------------------------- (Complete in Duplicate) ________________________________________ - ___ This Permit Expires 1 Year From Date Issued Date Issued hl'___lQ_��` 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. ,235" CbV �-7 D d�r7171� r JOB ADDRESS AND LOCATION . ' '!'" � _cc _ `� E p Owner's Name----- 1 �`� -!Yl'��- 1 -�" `r---� �-------------- � ll_- �G_ c o ------------------------------ ffII ff C - Address '2r�L id-�(�C -------------------------------------------------- --------- ------------------------•-- - } 1 � Contractor`s Name--- ----- --- = ---------- ��f a Phone----------------------------------- Installation will serve: Residence, partment House [] Commercial [] Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ____ Number of bedrooms _../Number of baths __3- Lot size ____.____-9- _ ___________________________________ 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 Loa m❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: {If yes,date------------.......-.) No�el New Construction: Yes No ❑ FHA/VA: Yes E1, No E] TYPE OF INSTALLATION AND SPECIFICATIONS: I (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well,,10_0_7-6stance from fpundatfon____ tMaterial__- __ ___._�— ---4 _---_ : No, of corn partments__ ..._.._ �Size_ �� 7 _ Liquid depth=__._._�_. ___ .___Capacity_� �0.:r�_-__. �� Dis osal Field: Distance from nearest well--6,.5........Distance from foun Din-----10----- to nearest lot J e.--z��____ I� T ___ j___.Width of trench--- f Number of lines----�--------f- ---- —Length of�e�� lin - -------�� :, - -----(---------------------- Type of filter material__-5__f_}_� --Depth of tfilfer ma#enaL____�__ ____-- --- otal length______--3---��___________________ ! Seepage Pit: Distance to nearest well----------------------Distance„from foundation______________.___.Distance to nearest lot line-. .. ' r ❑ Number of pits---------------- Lining"materiair_------- -__-----.Size: Diameter-----------------._.__Depth---.__----------- ---------____-- Cesspool: Distance from nearest well------------_____Distance from ❑ foundation_..________._-_..Lining material____----- - __._________________ Size: Diameter---------------- --------------------Depth------ ------- ---------------------------------1---LiGuid Capacity----------------------------gals. ' - ;fI`. Privy: Distance from nearest well;------------ ---------------------------------Distance from nearest bui4&n --------g--------------------------------------------- ------ --- ----- ❑ Distance to nearest,;lot line-- --- -------------- --------`- - -----------------------------•- -------=------------ Remodeling and/or repairing (describe): --------- ------ -------=------------------------------•------------------------------------------------------- � - ---------------------------=-------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------- -=- ----- - C .a t I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State -aws, and ules-and regulations of-the San Joa quin Local Health District. ---------------------------(Owner and/or Contractor)(5i --- (Sign � - 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---------------------------------------- - ----------------------------------- -- DATE--------------------------------------------------------- REVIEWEDBY------------------------- ------ ------------ ------------------------ ------------------------------ _ DA_E �? � . •------- BUILDINGPERMIT ISSUED----------•-- -----------------------------------------------—-------------------------------------- DATE------------------II---------------------------------- Alterationsand/or recommendations--------------------- -------------------------------------------------------------------------------------------------------_-•---------------------------- ------------------------------------------------------------------------------ ---------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------ ------- -- --------------------------------------------- ------------------------------------------------------------------------------------------------- FINAL INSPECTION BY: ----------- -------- --- -- r_---.__--- Date.------------- !Lp_�..�( 6-------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CC.