18239 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: ------------------------------------------------ APPLICATION FOR SANITATION PERMIT Permit No.-- �..... ----------------------------------- ------------------ - (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. 549. JOB ADDRESS AN LOCATION_ / ._ ------ ---- ------------ _ � / L j33 � Owner's Name �: l-1 ---:�; -------- - Phone�t ------------------ T .Cr ------------------------------------ Address----------- ].._-- , il 9 j /� ' -----------------------------------------------------•- ....--�-•-- ---•--/�-------------------------------- ------- Phone4i4Lf'�_Y to 7----•- Contractor's Name------ - ----------••-.-------•--_-•_-- Installation will serve: ence [9 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ I Number of living units: _ --- Number of bedrooms _9__ Number of baths -------- Lot size 1-0_V---r -J_ -_------ --- Water Supply: Public system Community system ❑ Private ❑. Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam jg�_ Clay Loam ❑ Clay ❑ Adobe E Hardpan ❑ Previous Application Made: (If yes,date....................) No A New Construction: Yes ❑ No ❑ 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-----------------Distance from foundation------------------- Material---------------_------ ----------- - _------- ❑ No. of compartments-------------------------Size------------------ ------ ------Liquid depth----------- -- - ---------Capacity----------------------- i Disposal Field: Distance from nearest well_________________Distance from foundation--------------------Distance to nearest lot line---------_----_-- ❑ Number of lines-----------------------------------Length of each line------------------------------Width of french-------------------------___----- Type of filter material---------------------_--Depth of filter material----------------------.Total length---------------------..____---___---____-__ Seepage Pit: Distance to nearest well_ �._` Distance from foundation_S�-X_°___.Distapl a to nearest lot line - Number of pits------ --------------Lining material_Si_n�GrA-Size: Diamefer.9,Td<,____.Depth. � �.._._._ ------------- Cesspool: Distance from nearest well-----------------Distance from foundation_____.----.--------Lining material--_- ----- ------------ J ❑ Size: Diameter-.:-------------- -----=--------- ----Depth----------------------- ------- --- -------------Liquid Capacity-----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ ❑ Distance to nearest lot line----- ------------------- ------ - ---------------- ---------------------------------------- - ---------------- ------------- Remodeling and/or repairing descri e ` f --------- -------------------------- --------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St aws, and rules and regulations of the,San Joaquin Local Health District. (Signed) .--� Y 'r 1-------------------------------- --------- ----------------------------- ---------(Owner and/or Contractor) By:----- ------ i ------ ----- _' ---------------------------------- -------------------------(Title)-- ` - ----- (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 I _ DATE----- --------------------- APPLICATION ACCEPTED BY_-----�--��----°- - -. -5---------------- --------------------------------------------- ��--`- I---"---�-- REVIEWEDBY------------------------------ '-------- --------- . -------------------------- ----- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED------------- -- ------------------------------------�{ ---------- DATE------- ----------------------------, Alterations a d or recomm ndations:--�"2--:---�_____ __ ___________�--------•-]-y15-i ----- 1 --- -------- - ' - tJ - ------=C_1r:1-k1- VV----r` �'--------------------- -------------------------------------------- -------------------------------------------------------- --- -- --------- -------- ------------I�1� t '.Mott -------A ---------A ---s+.6ei--------.Aa- pn------ -------- t FINAL INSPECTION BY: 4 # ``'` `' Date--.----) --- --- ---------------------------------------------- f SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haielton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F,p.Co.