21033 - Laserfiche WebLink

Home Browse Search

FOR OFFICE - : ----------------- - ------------------- ------------- APPLICATION FOR SANITATION PERMIT Permit No. ;-/,-g7=. ----------------------- --- --------------------- ------- (Complete in Duplicate) pp Pp ------ _ This Permit Expires 1 Year From Date Issued Oo Date Issued l---:-- Application is hereby made to the San Jf —Z30-17 'Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance ith County Ordinance No. 549. ` JOB ADDRESS AND OCATlON � - ------ w---------------- Owner's _'Na ¢?'!u-___ � __-------- r - -- •--------- ---- -- --------- --------- -- - ------------- Phone------------------------------------ - ------------------------- --------- - --------- Address - �. --------------------------------- ------------ Contractor's Name----------- s - Phone ---- -- -------------------------I Installation will serve: Residence dAparfine f House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --- Number of bedrooms "F_ Number of baths --/-_ Lot size --- Water Supply: Public system ❑ Community system ❑ Private 0 Depth to Water Table 12e__ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous�Application Made: (If yes,date--------------------) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: '^= --(No-septic fank-or-cesspool I.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 -------- ------ Disposa -� geld: Distance from nearest well_.-. n---Distance from foundation----/0----------Distance to nearest lot line--- Number of lines---------'�-------------------Length of each line-____,T--..--- - ------.Width of trench-.-.,---,----------------- --- - Type of filter material-------� R-_------Depth of filter material-----J ' ...... .. length-----A4,0_1--- --------------------- ti -, - aon-- -_-_--- Dista rest well from foundati - ..:..-__. Seepage- Pit: Distance to nearest to nearest lot line_------------------- El Number Number of pits----------------------Lining material--- -----------------Size: Diameter---------- -—--------Depth--------- ------ tCC� l Cesspool: Distance from nearest well-----------------Distance from foundation--__-------. - ----.Linin material---- 1 C [l Size: Diameter. ------------------Depth------------- ------------------------------------Liquid Capacity----------------------------gals . Privy: Distance from'newest well _-:-----_I-------------- --- "- __ _-_- --_Distance from nearest building-_--------------------_---___---_-_ Distance to nearest lot line._.__---.-.- r ------- ---------- Remodeling and/or repairing (describe):---_----. --- -- ?tee , �- :.. -------------------------------- R ---------------------------------------------------------'----- 1. __--- ----_'---------•-----------------------------------}------------------------------------------------------------------------._--:----------------------------------_--------_--------------------------_-------------- I hereby certify That I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State I s and rules and regulations of the San Joaquin Local Health District. E �i (Signed$-y--:----------n--- --- ------------- G ----------------------------------- and/or Contractor) --,- Titlej------ ------------------ --- (Plot plan, showing size of Idt,'loeation,of system in rel, n to wells, buildings, etc., can be placed on reverse side). Y FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED -.., ----- ---------------------------------=-------------- DATE- --------- REVIEWED -------------- BY -------------"` '-_=-E-- ~- — =-- —____=}= ---------------_DATE--- --------- .- BUILDING PERMIT ISSUED -- - --- ------------ -------------------------------------- DATE Alterations and/or recommendations--------- ----------------"------------------------------------ = - -----•----------------I------- ---- ------------------ •---- - --------------------------------------------------------- -------------------------------------------------------------------------------- I ------------ a --------------------•-------.------.-_---•----.---------------- i FINAL INSPECTION BY:-. -_ ••F/ Da+ -------------- ------------------ ---- --------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. g, 300 West Oak Street 124 Sycamare Street 205 West 9Th Street k . Stockton,California Lodi,California Manteca,California , Tracy,California F.P.Ca.