18469 - Laserfiche WebLink

Home Browse Search

F R OFFICE USE- --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. .!-_ L_..��_C� --------------------------------------------------------- (Complete in Duplicate) -`��/�� --------------- -_. -._ This Permit Expires ] Year From Date Issued Date Issued __ ____ _______ ______ Application is hereby made to the San Joaquin Local Health District for a perinit'to construct and instal he work herein described. This application is made in compliance with County O��. rdinan o. 549. JOB ADDRESS A L CAT ON_ _ _ ----- Y � - ---- • ---- -•---------- Owner's Name------ ------- • -•--- --------------- ----- ------ Phone.--- ---------------------- ------ - Address---------------------- c ----- - ------ --- - -- ------- Contractor's Name---------------- =- --------2-A----- ------ ----------- Phone_._ installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑�� Number of living units: -------- Nu er of bedrooms J7`�Number of baths _ Lot size ___.._ -- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Tableftf Character of soil to a depth of 3 feet: Sand [❑ Gravel 0 Sandy Loam ❑ Clay Loam ❑ Clay [] obe Hardpan C] } Previous Application Made: {If yes,date--------------------1 No E] New Construction: Yes E] No FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: o septic tank or cesspool permitted if public sewer is available within 200 feet.) Se - T Distance from nearest well_________________Distance from foundation-------------------Material------ --------------------------------___.._.__- No. of compartments------ ------------------Size--------------------------------Liquid depth-----------------------.--Capacity------------/------ os ie d: Distance from nea st w II . ___ _ _ istance from foundation___)r_. Distance to nearest lot line____-6 __-_-- J --f�-- r Number of iines_ -___ .. _---___ - _Length of each Iin� C �_____�Width of trench.-, _9_,--_-_- _ Type of filter materials_Depth of filter material----------/-____..Total length--------------------- i P' Distance to nearest well tor --Distancero foundation____fD__ _---.Di tonne to nearest lot — Number of its._--/ K �- f� p I---------------Lining material- -- ..........Size: Diameter-----1" �.--------Depth_��---------------------- 'W 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----------------------------- ..__..__..... 3 ❑ Distance to nearest lot line--------------------------------- ------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe)_________________ A nr -----------------------------------------•------•-------------------------•----------------------------------•--------------•------• ------- --------------------.----------------------.------------------- !d 1 e ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ r I hereby certify that I have prepared this application and that the work wil be done in accordance with San Joaquin County ordinances, Stat ws, d rule and reg atio of the)SSanJoa in LoH th District.1(Signed) . --------- Q /f� wn r Contractor) ,_By:----------------------------- ------------------------------------------------ N`- - - (Title)------------------------- --------- ---- (Plot plan, showing size of lot, location of system in relatwells, buildin s, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY �---------------------------------------------------------------- DATE =� =�� fry -' --- ---- REVIEWEDBY--------------------------------------------- -------------------------------------------------------------------------------- DATE------------------- ----- -- -- BUILDING PERMIT ISSUED------------------------------------------- --------------------------------------------------------- DATE=------------------ ------------ --------------------------- - -- ---------------------------Alterations and/or recommendations:--- ------------------------------------------------------------------------------------- ------------------••-----------•------------------------- ---------------------------------------------------------------------- ---------------------------------------------------------------------- -------------------------------------------------------------------------•--------------------------------- -------- ------------------------ ---------- ------------------------------------------ ------------------------------------------------------- ----- ------------------------------------ ----------- -------------------- FINAL INSPECTION BYE----- - --- ---- - - ------ �------.- - ------- Date------------_..-- -.- � -�-` ---.-----�--------------------- SAN JOAQ IN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.RCO.