20714 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: ' ------------------------- -------------------------- ------------- -- ------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. . ____l ... ------- -- -------------- --------- --- --------------- (Complete in Duplicate) -------------------- This Permit Expires 1 Year From Date Issued Date Issued .4�1�.-_._� 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. 2240_ 0(-0_24 SC G! -"--/C.tc 411EIJ/51DE JOB ADDRESS AND LO ATION--------- I LS----------14149---------UA 1-�NE- --------=----------------_M-T- ._- -. _ Owner's Name---------------••-� dY------------QI3. R"rsv 4_A__ --------- ..------------------ ---- ---- -------- Phone_"---_3-Z7ZD Address-...... ----------YY31------ ----------------M—_004------------------------------------------------------------------------------------------- Contractor's Name------FL?_LtF K,---------------------------•--••----------------------- ------------------- -------------• -------------- Phone----------- .----------_ Installation will serve: Residence [F]'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -1----- Number of bedrooms _ _._ Number of baths _/..___- Lot size7------ - Water Supply: Public system ❑ Community system ❑ Private Fr`6epth to Water Table - - ft. Character of soil to a depth of 3 feet: Sand ravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date....................) No ( New Construction: Yes [�No ❑ FHA/VA: Yes [rr 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--50_-_---Distance from foundation----1-0---_____--Materrial-_C�1�C�E ----------- ®� No. of compartments------ ----------Size__ x_1Q--- __57.Liquid depth------� Z...Capacity....lzop--- Disposal Field: Distance from nearest w I_.50.-----Distance from foundation----149----------Df'4�tance to nearest lot line_. --..... `� [ Number of lines- - ----------Length of each line_� _ _.Zc#th of french ------------- Type of filter mate rca!_.��_�K_._.Depth of filter material _____�`�.-.-------Total length___________ ______________ Seepage Pit: Distance to nearest well----------------------Distance from foundation---_.-_-------_-.Dis'fance 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---------------------------------------------- from nearest building_-_-__----.-_-._-__--_-._-.__.__-._..-_--. ❑ Distance to nearest lot line ------------ ---------------------------------------------------------------------------- ------------------------------------------------- Remodelingand/or repairing (describe)------------------------------- ---------------------------------------------------------------- -----------------------------------------------•-------- --•-----•---------------------•----------------------------------------------------•------------------------- --------------------------------------------------------------------------------------•------------------------ -----------------------------------------------------------------------------------------------------------------------------------------------------•---------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ 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) % o_ - ._,: ---------------------------------------------- --------------------------------------------- -------------------------------------- ---(Owner and/or Contractor) By:---------------------------------------------------------------------------------------------------------------------------------(Title)------r------ ----- ------------ - ----------.-.. ---- --------- (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 APPLICATION ACCEPTED BY----------rx-.s._R-v---------------------------------------------------------------------- DATE----- b_w '---------------------- REVIEWEDBY------------------------------------------------------ ---------------------------------------------•------------------------ DATE-------- -------------------------------------------------- BUILDINGPERMIT ISSUED---------------------------------------•-------------------------------------------------- ---------- DATE-------------------------- ------------------- -------------- Alterations and/or recommendations------------------ --------------------------- - ----------------------------------------- -------------------••----•---------•--------------------------------- ------------------------- ----------------------------- --------------------------------------------------------------------- -------------------------------------------•-- - --------- ------------------------• -- 1' : - f - -------------- ----------- -------- --------------------------------------------------------------------- r FINAL INSPECTI6P413 ----- - --- -------- / Date-----------t 1 ---4V1Z-------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1641 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.C a.