19008 - Laserfiche WebLink

Home Browse Search

/FOR OFFICE USE: ----_------------------------ ------- - --_ APPLICATION FOR SANITATION PERMIT Permit No. .. _Q_-r- (Complete in Duplicate) pate Issued ------------.a --- a ---____________.-_�_________________-___________.__- 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 ss��County Ordinance No. 549. JOS ADDRESS AND LO f TION_..._�'7�f_�____ _ 71 Owner's Name ----- Phone--------------------_- _j- -- ------------------------------------------------------------------------------------------------------•--------------------------------- ' Contractor's Name r Phone----•------------------ -- ---•-- - -----------------------------------------------•--- - �4,k Installation will serve: Residence [7K'A-partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _/__ Number of bedrooms -.g_ Number of baths _/___ Lot size {h___ ________________________________ Water Supply: Public system 9KCommunify system ❑ Private ❑ Depth to Water Table AY Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam 0 Clay ❑ Adobe 24--Hardpan ❑ ; Previous Application Made: (If yes,date-----------,--------) No New Construction: Yes ❑ No FHA/VA: Yes J9--'N0 ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) o ' MatefsDistance from nearest well___`_-_ __Distancem foundation--- --- Septic Tank: __ ` _� ___ No. of comPartrents____.A- /01 _,0 depth-- CaPouty--r� ----- l -_-________ Disposal Field: Distance from nearest well__ '____Distance from foundation_e�__._..Distance to nearest lot line__________ Number of lines--------/-----_fes__. _____ Length of each lire___ __ ____� f Y `_ Width of trench. _ Type of filter material_ _.. Depth of filter material_._eld'o Total len th___._ � Seepage Pit: Distance to nearest well-_-__--_�__-____Distance from fou dation__ ____.-- Distance to nearest lot line__ `____ ------ �, ! 2 / Number of pits----_/-----------_Lining material___ r2.QC/�__Size: Diameter____.___Depth;l •_,e l Cesspool: Distance from nearest well_________________Distance from foundation--- material---___._.._._-..-___._____________.__ (� ❑ Size: Diameter------}------------------ - ------Depth---------------------------------------------------.Liquid Capacity----------------------------gals. Privy: Distance from nearest well------------------------------------------------- from nearest building.._____________________________-________-. r ❑ Distance to nearest lot line------------------------------------------------------------------------------------------------ -------------------- 'r. �� y� Remodeling and/or repairing (descrikne)---------------- lne<ra'.�f/ �_� ____ V4.- _-- _ ---------------'`--_---------___--- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------- ----------------- ------------------- ---------------- ------------------------------------------- ---------------------------------------------------------- 1 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 ules and regulations'of the San Joaquin Local Health District. R I (Signed) . ......-- - ---------------(�or Contractor) ---------------------------------------------._(Qmwm# -----------------------{Title) .............................. (Plot plan, showing size of lot, location,of sysfe elation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY =-------- -- --- ---------------------------------------- DATE------ --- ---------= REVIEWEDBY------------------------------ ---- ------ -------- ---------------------------------------------- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED------------ DATE----------------------------------------------- ---------- -- Alterations and/or recommendations:----- ---------------------------------------•- ----------------------------- ---------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------- -------------------- ---------------------- ----------------------------------------------------- -------------------------------------------------- ----------------------- ---------------------------------------------------------------------------------------------- ---------- ----------------------------------------. - ------------ ----------------------------- --------------------------- ------ ------------------- ------------------- -------------------------------------------------------------------- ---------------------------- FINAL INSPECTION BY:-__!-_-_-- - -- �G - ..... Date SAN JOAQUIN LOCAL HEALTH DISTRICT 7601 E.Hazelton Ave. 304 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca, California Tracy, California F.P.Cp.