20337 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: --------------- --------" APPLICATION FOR SANITATION PERMIT Permit No. C__a. ... -------------- - --------------------- --------- . _ (Complete in Duplicate) Date Issued _-r� � ------- - This Permit Expires 1 Year From Date Issued psi Application is here_by 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. L ZIP JOB ADDRESS AND LOCATI N � .�� ± ✓ 117C -------------------• -- -------------- Phone------------------------------------ Owner's Name---- ,, ---- -- r - --------------------------------------------------- Address -------•----------- Address-----. 3--- ------ Phone------------•---------------•------ Contractor's Name------ - Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -- Number of bedrooms _-. _ Number of baths -xY Lot size -----=---------------------------------------------------- Water Supply: Public system ❑ Community system ❑ Private �4epth to Water Table -------- 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--------------------1 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.) Septic Tank: Distance from nearest well-----------------Distance from foundation-------------------Material..--_-----------------------------_------------ •-� Liquid depth------ ----------------- -Capacity--•------------------- ❑ No. of compartments-- ------------- --- ---Size----------- IIIII �a / �y Disposal field: Distance from nearest well___-��-.P."-.-_Distance from foundation-""�Q-..__-"""--Distance to nearest lot line_-��...""_-"_"_"- 1 Number of lines---------j--------'---------------Length of each line-------0--P_ -------------.Width of trench----2-----,-- -•---- Type of filter material----"9",IZ----____---Depth of filter material------/y-!`.-_""-Total length--_--4/�-_/------------------------ pI i Seepa it: Distance to nearest well-_--"�Pb----'�"Distance from foundation--------�__-- -"--.Distances o nearest lot line_ - _--___-_- pitsm ----s_RSize: Diameter-_- __-.3-3. Dept h".-.-z-r------------------ Numberof l --- - I I Cesspool: Distance from nearest well----.------_- Distance from foundation--------------------Lining material-_-.-.".--_---- { F1 Size: Diameter--- Depth--------------------- ------ ----------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well--------"-------------------"""-__ _,.-__""Distance from nearest building-____--."--___-- -- ----------- --------- ' ❑ Distance to nearest lot line---------------------------------- -------------------------------- ----------------------------------------------------- k Remodeling and/or repairing (describe)--------------------- ------------------- ----------- ----------- --------------------- rc -Y� ----------------------------------------------- f ---------------------------------------------------------------------------------------- f --- ------------------------------------------------------------------------------------------------------------------------------------------------------------ I hereby certify I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State ws, a d rules and regulations of the San Joaquin Laca1 Health District. {Signed)------- ---- -------------------- -- --- -- --------------- -------------- ----------------------------------------------------- n r Contract ` d/o or) By:----- ------------- (Title)---------------- - - ------------------------ ------ {Plot plan, showing size of lot, location o system felation to wells, buildings, etc., can be placed an reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---------- DA7E ----- j "G - ------------------- REVIEWEDBY----- ------------ ----------------- ------------ ------------ ---------- -------------------------------------------- DATE------------------------------------------------------------ BUILDING - ------------- -------- ----- ----------- DATE-----------------------------------------------•------------ BUILDINGPERMIT ISSUED-------------------------------------------------------------- ----------------------- --------- DA•TE------------------------------------------------------------ Alterations and/or recommendations:------------------- -------- -------------- --------------------------------------•--------------------------------------------------------------------------- - - ----------------------------------- ------------------- ---------------- -------------------------------- FINALINSPECTION BY:..-_ --------------------- Date--- ------------------- ------------------------------- ------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Slockton,California Lodi,California Manteca,California Tracy,California F.P.C❑.