20591 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: -- -------------- -- ----------------------------------- APPLICATION FOR SANITATION PERMIT Permit No,caZz9,_�:.Z!-_ --------------------------------------------------------- (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 ad I compliance with County Ordinance No. 549. E f� JOB ADDRESS AND LOCATION--!_--- �- --- -- ------ ------Me t 9 �1�'./•'-- / � �1t_. Owner's Name__ ,L� - �`" `�-� t Phone_�7_0 3 ¢` -•- -------- --- Address 1�-.2 -------------'.._.-- - Name ------ Contractor's - ---- Phone----------------------------------- ---- will serve: Residence ;' Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -_.2___ Number of bedrooms _-'/- Number of baths -:7____ Lot size --------- ------------------ Water Supply: Public system ❑ Community system ❑ Private X Depth to Water Table dv-.,ft. I 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 ' No E] FHA/VA: Yes ❑ No T TYPE OF INSTALLATION AND SPECIFICATIONS: 1(`� (No septic tank or cesspool permitted if public sewer is available within 200 feet.) �\ i Septic Tank: Distance from nearest well__�0 __- ____--Distance from foundation___1_ -______.Materia/_____ _ __ _______ __._ ___ _ ._. -_O__--__ _. �. No. of compartments-------.o2-------------Size__j61 _7_X7.1/_---Liquid depth----------6_ ---------Capacity./F ___6_XZ Disposal Field: Distance from nearest well-._-S ---.._Distance from foundation._/a-_f___-.Distance to nearest lot line_______�___t- Number /Number of lines-------------.?------ ___-- Length of each line_�Qx--gQ-��Width of trench-----_f?�.____--�--------------- Type of filter material----e -Depth of filter material____l�_��.__._Total length____.__Oz _G--------------------Seepage Pit: Distance to nearest ell---1-Q_U_`__._Distance fr m f undation__Ag Oe_____-Distnce to nearest lot line__ U�r___-of pits._..- -----Lining material___i ..__-Size: Diameter___._._-.._-.___Depth___a --------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------- ____.____.________-.-. ❑ Size: Diameter--------------------------- ---------Depth----------------- ----------------- ------------Liquid Capacity-- ------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-----------------------------------------. ❑ Distance to nearest lot line-------------------------- - - ---------------- ----------------------- ---------------------------------------------------------------------- Remodeling and/or repairing (describe):-.------- - -------------------------------•--------------------------- ---------------------------- ------------------•---------------------------------------------------------------- --------------------------------------------------------------- ------------- - ------------------------------------------------------------ ------------------------------•---------------------------------- - - --------------------------------------------------------- ----------------------------------------------------------------------------------------- ---•-------------------------- -------------------- - -- 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, and rules and regulations of the San Joaquin Local Health District. (Signed) - -----------------�-�--------_--------- ---------------------- ---- - canerand/or_. -_- ractor; . . __.. (O ont C I - - ------------- ---------------------------(Title)----- ------- - ---------------------- ... BY------------ (Plot plan, showing size o ot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY e / ------------- F APPLICATION ACCEPTED BY � �- '�- - rtes"~ DATEJ / REVIEWED BY------------------------------------------- - - ----------------- DATE �. --------------------------------------------------- - -- - BUILDINGPERMIT ISSUED-------------- ---------------------- ------ DATE----------------- --------------------- `l♦. I Alterations and/or recommendations------------- - --------------- -----------------------------------------------•------------------------------------------------------------------------------- - - - - - -------------1--------- FINALINSPECTION BY-- --------- ---- - -------------------- Date... -.-._/-_^-- -- -6-/ -— - - ------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.0 A•