21441 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: -- U-.'5� ------------------- -� 1 APPLICATION FOR SANITATION PERMIT Permit No. .:. � ...._--.0 ------------ - --- -------------- -- --------------- (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 made in compliance with County Ordinance No. 5 E�Gr4S`77.-+E_ �LG�/ 4�� '01C--/ -� CC JOB ADDRESS AND LOCATION ------ r---------- a ------ ,---------- '�c c f•m ].......... ------------------------- Owner's Name----------------••------------ <- a� y -----/---------- -- ---- --- -- Phone-- 1� ---- -Address--•---------- ----•----•-••---5- - Contractor's Name---------�n-- - -- ------ --------------------------------- ----------------- ---------------------------- ---------------- Phone----------------------------------- Installation will serve: Residence K Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms --- -- Number of baths -J--- Lot size --.._.. c7 ---_-------------- ----- Water Supply: Public system ❑ Community system ❑ Private K Depth to Water Table2� ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [❑ Clay Loam ❑ Clay ❑ Adobe or Hardpan ❑ Previous Application Made: (If yes,date--------------------) No ❑ New Construction: Yes ❑ Nog 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 from foundation------------------ Material---------------------------------------- � lg'Py No. of compartments---------- ---------------Size----.... --------------------Liquid depth--------------------------Capacity Disposal Field: Distance from nearest well_._.S.0------Distance from foundation.---/--0---------Distance to nearest lot lire-NTK.- "if rb'rj V�— Number of lines---------------- ------------------Length of each line-----------�-4_ _-------Width of french------��-�-------------_-_--- Type of filter material----./?=a_Ck--------Depth of filter material----- ---.---Total length----------IV-D---------------------- Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------------- Distance to nearest lot line----------------- E-1 Number of pits----------------------Lining material_----------------------Size: Diameter----------------------Depth--.----------------------------• Cesspool: Distance from nearest well-----------------Distance from foundation-----..-------------Lining material----------------------------------_-- ❑ Size: Diameter------------------- - ----- ----------Depth-------------- ---------------------------- Liquid Capacity- -------------------------gals, w Privy: Distance from nearest well-------------------------------------------------Distance from nearest building..--------------------------------------- Distance -- --.-----------..-_------- Distanceto nearest lot line- --- ------------------------------------------------------------------- -- - ------------------------1- -------- ------------ --------/. Remo ling and/or repairing (describe)---------- -------1---- i7�a-c- --.------: --------L+------ ---t - /d - - lrt-d- / /tlr' r ----------------------------------------- ----------------------------------------------------------- �/ 3 r ----------------- ------------------------ ------------ ----------- ------------ --------------------------------------•----------------------- ------------------------------------ -- ------------------------------------ ....... 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) syr - --- ----------- --- ----- ------------------------------------------------- ---------------------------(Owner and/or Contractor) By: --------------- - a --�- =_:-.>:r,-.- -------- - --- --------(Title)---------------- -------------- ----------- .--- ---------- (Plot plan, showing size of lot, location of system in relation to"wells, buildings, etc., can be placed on reverse side). t l R DhPARTMENT USE ONLY �}} APPLICATI1N ACCEPTED BY----- ] ;------------ -------------- = DATE------- ..f1 ------------------------ REVIEWb BY---------- ' -------------------- - = --------------------------------- DATE - -;- --- --- BUILDINGPERMIT ISSUED .-„---------------------------------- DATE------------------ ----------------------------------------- _., Alterations'and/or :recommendations----- ---------'-•----------------------------- ------------------------------------------------------------------------------------------------------------ -- r -------------- -------------------------------------...----------------------- --------------------------------—-----------•--------------------------•- -----------•------ --------------------------------- -- ----- ----------------------- ------------------- ---- ------- --------------------------------------------- ----------------------------- I y FINAL INSPECTION BY: Date r� " -----�-�f-------------- -------- ---- S JOAQUIN LOCAL HEALTH DISTRICT 1641 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Mantecar California Tracy,California F.P.C C.