18381 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: ------------------- 3 APPLICATION FOR SANITATION PERMIT Permit No. ... ... -�---------- --- ---.---_� (CiDuplicate)omplete n upcate) - - 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 made in compliance with County Ordinance No. 549.p, ` litl3' N JOB ADDRESS AND LOCATION._4X-f W-A Owner's Name------- - - ----------------------------------------- Phone-__------------------------- Address----------�r -- . ------ --- --- ---------- +� ��s------------------------------•-------------------------•------•-- '13 Contractor's Name-- ------------- --��-----�� .-------- Phone. Installation will serve: Residence [Apartment House E]"-Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living "units: _/_ Number of bedrooms .3--"Number of baths - Lot size __ /L`�� ______________________ Water Supply: Public system p Communitystem [-] Private Depth to Water Table 4.t. ` Character of soil to a depth of 3 fest: Sand E] Gravel ❑ Sandy Loam E] Clay Loam Clay ❑ Adobe E] Hardpan ❑ Previous Application Made: {If yes,date_4------------- ----) No New Construction: Yes 22,/f o ❑ FHA/VA: Yes ®' No ❑ r TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) f .}Y� I , Septic Tank: Distance from.nearest w I _-___Distance from ndatiion_-Ae---------Material-__ .___:_ .; i � -LEquid depthr Capacity ------------ ;L -- No. of compartments__. _Siz �' ---__Ca acit ��' Disposal Field: Distance from nearest weli._ ____Distance from foundation_ _ Distance to nearest lot line_ .r i Number of lines______A_---_ . f Length of each line_ - Width of trench ____._______.-_________- !lV .. F -� ----- - --, ]i------- j Type of filter material__//� *Depth of filter material_.--_--_-____Total length,_�� ----- Seepage Pit: Distance to nearest weli___,f�f __--Distance fr m foundation__. _____.___.Distance to nearest lot , -__-_ Number of pits_____ ___________Lining material__ _ � lG--Size: Diameter_ ,_� __Depth ✓.c , Cesspool: Distance from ,.nearest well____.____--_-- Distance from foundation--------_---------_Lining material---------------------------------___- ❑ Size: Diameter-71 - --------- ------ ------Depth Liquid Capacity gals, . tDistance from nearest building Privy: ..Distance from nearest well-------------- -- ------------------ - - g------------------------------------------ ❑ Distance to nearest lot line---------------------------`------------------ ------------------------------------------------- -------------- ------------------------------ Remodeling and/or repairing (cies nribe�:------ 4��--- -----------------------------------------•------------------- I I -------------•----------------------------------- = —— ------.-.-_.. �_- --------------------------------------------------- ----- :- -------�--� ------------ -------- = ---------------------- ----------------------------------------•------------- — - ------------------------ ------------------------------------------- ------- --------------- 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] -. ---------- = ( Contractor] y(Title)--- - ---- -----_---------------- By: r- _ -1 1 -:----,:----,aa,.�;, -:- - --- �` '"r (Plot plan, showing size of lot, location of system in re n to wells, buildings, etc., can be placed on reverse side). FO DEPARTMENT USE ONLY i i APPLICATION ACCEPTED BY_____ _ _ _ ____ _------ /_ _ _ _ ____ DATE____/' .. �� ` '-- - - --------------- BY-------------------------------------------- - ------- ----- -- -------------•---------------------------------------- DATE.........•-------------------------------------------------- BUILDINGPERMIT ISSUED---------- -------------------------- - ---- -----------------------k--------------------'-------- DATE.-----------.----------------------- -------- c�T�`�------`-r' =--)-=-------` Alterations anreeccoolnmendations:__-._, t I ----------------------------- ------------------------•--- ----------- - ------------------------- ----- - - ------------------- --------=--------- ---- ------------ ----------•-------- ----------------------------- ---------------------- ----------------------------1----------------------- FINAL --- ------------------------ FINAL .INSPECTION BY:- Date----- l/ � -------------------------- ----------rAN'JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Koxelton Ave. 300 West Oak Street +. 124 Sycamore Street 205 West 9th Street ' Stockton,California y Lodi,ialifornia w4 Manteca,Collfornio, ,t H Tracy,California F.P.c U. t