22170 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: ' T _frw� -------- ------------ ------------ -------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. .. D , -------------------- ---- ------------------------------ (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 Ordinance No, 549. JOB ADDRESS AND LOC ION-- `- --- -------------------- ,.` --- ----------- pv Owner's Name------ A --- -------------- -- ------ ---- -------------------- ---------- ---------- Phone. /_r,7:7_,2 7 C _...... Address---- Contractor's ddress---Contractor's Name . ---------- t '' Phone.. Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court M_-IM0,0tel ❑ Other ❑ Number of living units: --g Number of bedrooms _02- Number of baths _I - Lot size ------1-o ----------------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table _�Wft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe gao HardpanON Previous Application Made: (If yes,dote....................) No ❑ New Construction: Yes ❑ No EV FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) nk:, Distance from nearest well-----------------Distance from foundation------------------ Material-.----__-_____--_----.-..-_------.----...__----. No. of compartments--------------------------Size--------------------------------Liquid depth--------------------------Capacity----------------------- Di osaI Field: Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line--_--_----------- Number of lines------------------------------ ----Length of each line---------------------------._ Width of trench----------------------.-----_------ Type of filter material-------------------------Depth of filter material-----------------------Total length___.-------------_--_---_---..------.---_ � ,," �� t t Seepage it: Dis#ante #o nearest well- l�Dt1 ..-Disfianc foundation---/-,S--------- to nearest lot line..--Q-__ Number of pits------/-------------Lining material--_G_/�-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 lot line-------„---------- - - ----------------------------------------------------------------------------------------------------------- ---------- Remodeling and/or repairing (describe) --- '-ems_ ---- -------- -------- � hp -,-- - -----------------------------•-------•------------------------------------------------------------------------------------------------------------------------------------ ------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, &Sfriteaws, nd rules and egul i ns of the San Joa uin Local Health District. 1 1 (Signed) -------� -------- ----------------- IOW.er an” or Contractor) By-------------------------------------------- '----- - ------------------------------(Title) - ---------------- (Plot plan, showing size of lot, location of system in relatio wells, buildings, etc., can be placed on reverse side}. F R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-.--- ---- - ----------------------- --- ------------------------------ ------ DATE----- REVIEWEDBY------------------------------------- I--------- ----1-- -------------------------------------------------------- DATE------------------ BUILDINGPERMIT ISSUED------------ --`------------------------------------------------------------------------ ----------- DATE.----------------- ----------------------------------- ' Alterations and/or recommendations-- ------------------------- ---------------------------------------------------------------•--------........---------------------- ------------------------ -- ----------------------- i -• -------------------- ----------- - ------------ � -A ------------ - --_�-------------•------------------.---------------- --- ----------------------- --- -- - - ------------- -- _ � �izr� 1fyt t 4 ' � c�/- -- --- ----� 0'�! � "6_11 y� f FINAL INSPECTION BY:- Date =. ��--------------- -------------------------------- S N JO QUIN LOCAL HEALTH DISTRICT 1601 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stackton,California Lodi,California Manteca, California Tracy,California F.P.CC. 1