21103 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: ------------------------------------------------------ APPLICATION FOR SANITATION PERMIT , ' Permit No. _l..1p_3 ---- -- ------------ ------------- -- --------- - - (Complete in Duplicate) This Permit Expires 1 Year From Date Issued 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 made in compliance with_County^Or finance l o. 549. JOB ADDRESS AN. CATI `Z4e - - - ____.____. r Owner's Name__.{ =(�� '�------ ----------- ------ -- ----- Address------------ - - --. - -. ----� ----------------------- Contractor's Name !C�...�_ /�.L� ' a_--- ------ Phone.. --------- - -----❑-------------------•-- ❑ Motel Installation will serve: Residence Apartment House ❑ /Comme cial Trailer Cour} ❑ Other ❑ Number of living units: -�_---- Number of bedrooms __4/ Number of baths �__ Lot size ____ __ _______ _ _ __ -----• -- -------------- Water Supply: Public system ❑ Communitysystem �ivate Depth to Water Table---S....Y � ❑ p �..__ 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....................l No New Construction:, Yes No ❑ FHANA: Yes ❑ Nol J TYPE OF INSTALLATION AND SPECIFICATIONS: +� f (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se ti Tank: Distance from nearest well_ __; --Dista �/fr rrfoun/dation __- .Mat rial_ �apacity____ • ---- sal Field: Distance from neare t well _;)_p-._._Distance from foundation___. _f��__.____ p - - / - - -D' to nearest lot lin - Number of lines--- --- -- ----------- -Length of,'eachine__�J�-E�__`/ Q � /Akh of trench-- 1/G1r : ' � _ t .. - --------------------- Type of filter mal 1> __!____- l—Bepth of filter material_____ _ ____ ______Total length_-___ �_, ,--------_-------.- Seepage Pit: Distance to nearest well------_---------------Distance from foundation--------.-----------Distance to nearest lot line----_.-.--------- ❑ Number of pits-- _------------Lining material-----------------------Size: Diameter----_------------------Depth-------------------_---- 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 Ione ---- ._ = ------------------------------------------------ ------------ r Remodeling and/or repairing (describe):---------- ------ d ----------------- -----------------•------------------------------------------------------------------------ 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 laws, and�ruan/d r uI tions of the San Joaquin Local Health District. Q'----� / L X(Signedl- i , �- (Owner and/or Contractor By:------------------------------------------------------------------------------------------------------------------------------------ ) (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 F APPLICATION ACCEPTED BY----__-----_.___..______-- ATE__ REVIEWED BY ATE_ • _ BUILDING PERMIT ISSUED - `-- DATE - _.�-_ �L Alterations and/or recommendations:________._ - ---------------------------- --------------------------- ----- -- - ---------------- ---------------------------------•--------------------;------------------------------------------------------•------------ -- - --------------------------------------- ------------------------------ xW------------ --------- ----------------------------------------------------------------------------------------------- r ----------------------------------- r FINAL INSPECTION BY:........ -� -- - -_, ------ --------- -------------------- Date......------- !!Z� SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 F.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9Th Street Stockton,California Lodi, California Manteca, California Tracy,California F.P.CC.