20269 - Laserfiche WebLink

Home Browse Search

1-UKUl-l-K-t USt: p ---------------------- ------------------------------------- __.______-_____ APPLICATION FOR SANITATION PERMIT Permit -------- -- --- --F -------- ------------------- (Complete in Duplicate) II This Permit Expires 1 Year From Date Issued Date Issued ApplicAion is hereby made to the San Joaquin Local Health District for a permit to construct and Inst If the work herein described. This application is made in compliance with County Ordinance No. 549. _AD JOB ADDRESS A LOC( ! LON �CA - pa +' t----------------------- I Name _ O Owner s. ------------------- -------- Phone-------------------------------- Address --------------------- - Address!------44-44... ---------k_.---- ----- - ---- r ---------- -- c Contra Name____ _ _________ ---- Phone------------------------------- Installation will serve: Residence [f*Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___�__ Number of bedrooms -3-- Number baths _if -- Lot size ____ -r� _-__------------- Water Supply: Public system ❑ Community system ❑ Private Number to Water Table -------- ft. Charactb r of soil to a depth of 3 feet: Send ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Z("Hardpan [❑ Previous" jApplication 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.) Septic Tenk: Distance from nearest well-----------------Distance from foundation__.-----------------Material ❑ No. of compartmentsSize--------------------------------Liquid depth------- ---- ------------Capacity ------------ 1 Disposals Field: Distance from nearest well_________________Distance from foundation----------------:�--Distance to nearest lot line___-_______-_____ 1 ❑ Number of lines-----------------------------------Length of each line--------------------------.--.Width of trench----------- ---------------------- � t i Type of filter material-------------------------Depth of filter material---------------------_Total length---------------------------------- -- --- Seepa s it: Distance to nearest well------1_10ed_r-----Distance from foundation----/Q----------Distance to nearest Iot fine_- s_----._ Number of pits--------f........ __Lining material----�_� --t------Size: Diameter____ ,,- _"� ---Depth_.---2•-s f___-_._ 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---- -------------------------------- ---- Remodel ing --Remodeling and/or repairing (describe)------------------ ------ - - ----------------------- ------------ ------------------------- -------� Z------ -- ---•-------- ------- --------------------------- --- ----------- --------------"----------------------------------------------------------------•------------------------------------------------------------•--------•------------------------------------------------------- ------------- -- -' - -----------------------------------------------•-------------------------------------------------------------------------•----------------------------- --------- 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, rules and regulations of the San Joaquin Local Health District. ii (5igned)-��------•-------- ------------- /or Contractor) gY•--------------- - -----------------r-------^_`__Psys;f4emin '-� -._ ---------------------------------------------(Title----- - ._ - --------------- ---.-------------.-.- (Plot plan", showing size of lot, location orelation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---------- ----------- ------------------------------------------- DATE__._3---- � --------------------------------- REVIEWEDBY----------------------------------------- --- -------------------------------- --- -------------------------- -------------- DATE-------- ----------------- ---------------------------------- BUILDINGPERMIT ISSUED------------- ---------------------------------------------------------------------------------------- DATE ` -- Alterations and/or recommendations:--------- ---------- ----------------------- -----•-----•-------------------------------------- ------------ -------------•--------------------- - --------------------------------------------------------------------------------------•---------- --------------------•------------------------ ---------------------- -- -----------------------------•---------------- ------------ ------------ --------------------- ------------------------------------------------------------------- ------------------- ------------- FINAL �rINSPECTION BY: -+ ---------- Date__ -��L SAN JOAQUIN LOCAL HEALTH DISTRICT r 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi, California Mantecar California Tracy,California F.F.CU.