19247 - Laserfiche WebLink

Home Browse Search

F R OFFICE USE: f, r-- t:•.R APPLICATION FOR SANITATION PERMIT Permit No. 41-2 .. ..... � m lefe in Duplicate)t ` --------- -- ---- (CoDate 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. �4 JOB ADDRESS AND LO T ON-��__ -3--- �8 ...... ---.- Phone------------------------------------ Owner's Name------ -----•- - ` Address_-_-....----------- �'= -------------------- --------------••----------- . ___ � ------Contractor's Name_______ ______. _.�. - � ' ---' - � ------------ -- -------------- Phone--------------- -----•- w' Installation will serve: Residence ®Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms -,l... Number of baths -,/-- Lot size ------- ......------------------ I Water Supply: Public system ❑ Community system ❑ Private [Er"bepth to Water Table S ft. i Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay [dobe ❑ Hardpan ❑ Previous Application Made: (If yes,date--------------- ----) No ® New Construction: Yes ❑ No �HA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: y' (No septic tank or cesspool permitted if public sewer is available within 200 feet.) t�ITaAk: Distance from nearest well-----------------Distance from foundation--------------------Material--------------.-----------------------.---------- No.'of ___.___.No.'of compartments- - - Size--- f---------/---------Liquid depth---- ---------------------Capacity----------------------- _J Disposal Field: Distance from nearest well�Z,0Q_Distance frosri foundation-_/A._____..Distance to nearest lot line_,�_-,!/ Number of lines______/_____________ Length of each line____ t ----------------Width of trench-07V_ y s� ,Type of filter material.`! ___ Depth of filter material---., _____._Total length_---�_ --_-----T -------------- Seepage Pit: Distance toTnearest well__,244.-------Distan m fo pdation_ _ ��.Dista s� to nearest lot line ___ Ili ° Linin material__ d_�_-_. {Size: Diameter__ i�,umber of its---- v� Depth ' Cesspool: ;" Distance from nearest well________________Distance fr�m foundation-_-.__-------------Lining material---.-----------------------.______-_ Q, ❑ _ Liquid Capacity gals. 1 Sizer,'Q�ameter--------------•-•••••_•-••-- -----'----Depth----------�-------------- '- -s-�---- -------- 9 p Y---'--------------'---------g -__._-._Distance from nearest building Privy: Distance from nearest well---- ---------------------- 9 ❑ "` ----------------------------------' - ----- ' �. Distance to nearest lot 11ne-------------------------•---------------�--- - -------- Remodeling and/or repairing (describe): =------------------------- ------------------ ----------------------------------------------- I----------------------------------------------- ________________ '_____.____.__.________.__________._______-________________ ----------- -------------------------------- _y-________________-_________.___ _. _-_-.-_____.-______-_---_-_..____-______-._____-------_-._ _ter.,� _! t ' ----------------------------------------- -__L ___,-_---____---____-_____________ ______---__-__________________-______________--__----_________________________-_----1____-_-________.____-____________--.____.-.--___-.-.___- I hereby certify that I have prepared this application and that the work will1e done in accordance with San Joaquin County ordinanceailed w , and rs ad regulations a the San Joaquin� 'tical Health District. ...........(Owner and/or Contractor) (Signed) - - ------- --------- ------�------------------------------------------------------------ ` By:----------- -----••-•-------------- —-- -------- --------- ----------------------------- ' (Title} (Plot plan, showing size of lot, location of system in rel on to wells, buildings, etc., can be placed olf reverse side). FOR DEPARTMENT USE ONLY R - ----- DATE =� � ` ------------- APPLICATION ACCEPTED BY.--- --•-----:-----'- '.---'--- - -- ------------- --• -C ---- �------- --- - -' -- - REVIEWEDBY-•--•-----------------------------_ `---- ------------ ---- ----------- DATE--------------------- ------------------ ---------- ----- BUILDINGPERMIT ISSUED------------------'.----------------------------------------------- -t------------ DATIr------------ ------------ ------- and/or recommend at ions:- j 77--} 1- -------(---C--.------- ^it-r�� .�� `y�'�.c�f �=�'`�� - ` 2� 71:-- Alterations .--------6--'---r-'-- .... 1 C. ------------------------------------------------------- ------------------------------------------------------ ----------------------------- ---- ---------------•----•-•--------------- --------------------------------- ------------------------- --------- --------- ---•--------------------- -----'-'------------------------------ XK FINAL INSPECTION BY:---- �—--- Date---- y �_ -------. ----------------I---------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California r.a.c n. I