18731 - Laserfiche WebLink

Home Browse Search

R OFFICE USE: 30 -4N SS--- -------------- -::¢�-.-- APPLICATIONIFOR SANITATION PERMIT Permit No. ---------- ..1.- ------------------ ------ (Comp[ete in Duplicate) q 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 a install the work herein described. This application is made in compliance'with County Ordinance No. 549. JOB ADDRESS AND L ATION--- ., l 3 ---- 7 ---- -------------------------------- ------- ----------- Owner's Name-----------, ------ ----- ----- --- ------------------ Phone- -- --- --fl, Address- .. .... ------ , Contractor's Name- Installation will serve: Residence partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --/-- Number of bedrooms _Number of baths _ ___ Lot size ------------- Water ___________Water Supply: Public system Vommunity system ❑ Private ❑ Depth to Water Table 6) ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ dobe Hardpan ❑ Previous Application Made:- (if yes,date__.. _..__.------) No ❑ New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) yam, , Septic Tank: Distance from nearest well_�l !Disfanp from.,founn afron_____r ` __.M�3�yriaf_________ No. of compartmen#s___ -__.___._:__5ize __7 _ _ `�_____Liquid depth_s1- _ _.___._.Capacity__ ____ Disposal Field: Distance from nearest well_ a�rDistance from-foundation_ l Distance to nearest lot line________ ._�_ Number of lines_____ _,____. _ __Length of each knef8_-!�.-______Q,__-Width of +rench-_.j_4Q1!4___.�____.___ . Type of filter materi Depth of filter material__..__,r�9___ Total length---------_.------f ! { Seepage Pit: Ristance�to nea're well_. _. _____Distarice.fi-om foundation____. ' _�__. Distance to nearest lot line_______ '- N x Number of ---------------Lining Lining material___��t� lunclafion. _.__.Size: Diameter----�_,�.__r_.Deptn_-.��______ _____.__: W Cesspool: Distance from nearest well------------------Distance from -.-_._._.________.Lining material------------------------------------- Size:'Diame+er-------I-------- ----------------------De th----------------------- - ---------------------Li Liquid Capacity ❑ I p q --------------------------;gals., - Privy: Distance from nearest well___....-------------------___-----------------------Dis+ante from nearest buildin.g------------------------------------ ❑ Distance to nearest lot line--------------------------------- -------- - ------------------------------- ---------------------------------- Remodeling ._ - ----• -Remodeling and/or rep i g (describi):--- --- - ----------------------------------------- - ---------------"�---------- ----------------------------------- ---------------------------------- - -------------------------- ----------------•----- -------------------------------------------------------- ---------------.-------------------------------- -- -------------------=---------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------- I hereby certif that'l have prepared this application and that the work will be done in accordance with San Joaquin County L ordinances, S e s, nil rules and regulations of the San J'oa in Local Health District. (Signed) ------ . . > �'E �Ar Contractor) g (Title)- -------- -- ------- Y•-------------------•-- - ---------------------------- ----------------------------------- (Plot plan, showing size of lot, location of system in relation to w Is, buildings tc., can be placed on reverse side). y f FOR DEPARTMENTU E ONLY APPLICATION ACCEPTED BY r DATE -_1�, -------------------------------------------- -------------- DATE-------------------------�---------------------------------- REVIEWED BY-------------- ------------- - ING ----------- Alterations oris and/or recommDendations:-----�.�/�.-��------------------- ---------- -------- -- ----- DA•TE------------_----_--------�--------------- ----------------- ---- -=: e �� Fc i I ---------- ---------------------------------------------- ---------- --- ------ ----------------------------------------------- ----------------------------------------------------------------- ------------------ --------------•--------- ---------------------•------------------ --------------- - ------ ------------------------------------------- ------------- ----=--------------------------------------------------------- i ._. _/. ._ Date rte '` FINAL INSPECTION BY:../i ae / --------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT r 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.co.