11695 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit. No. (Complete in Duplicate] Z. Date Issued - r• ----------- Irl , 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. JOS ADDRESS AND LOCATION... Owner's Name____ 4.c_ " ------<2060 --------------------------------- --------- -------- ----- ------------=•--- ----------=-Phone------------ ---------------------- /jy� Address . g ��' I'� ----------- ----------- ----- ---- - -------------------•------------------------------------- Contractor's Name-----t ``� --------------�------ ----------- -- -- ------ Phone_ --V-- Installation will serve: Residence A artment House ❑ Commercial ❑ Trailer Court ❑ Motel [1 Other E]Number of living units: I----- Number of bedrooms _3--- Number of baths J---- Lot size __411_x '/ -�d----------------------------------- Wafer Supply. Public system 4 Community system ❑ Private ❑ Depth to Water Table __fie-ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobejQ Hardpan ❑ Previous Application Made: Yes ❑I No K New Construction: Yes No-E] FHA/VA: Yes ❑ No k TYPE OF INSTALLATION AND SPECIFICATIONS- (No septic tank or`cesspool permitted if public sewer is available within 200 feet.) I Septic Tank: Distance from nearest ' e Guo well_---7)d Distance from foundation__��________.Material_--_-- ___ No. of compartments_.____....' ,,-......_._Size__.. _ a_-- :-__Liquid depf-h--- 1---'---_--------Capacity__�qd Disposal Field: Distance from nearest weft__ Distance from foundation._r-�---______.Distance to nearest lot line__'.-_____ Q! Number of lines---.------:3---------------------Length of each line_____s..4?�__________________Width of trench___..ZY__---______.__.________ OV Type of filter material____"2_*C-�-------Depth of filter material----- 9—_*---------Total length------ -------------------------- — ` W Seepage Pit: --bisfance to nearest wefl-------— �d `-_-______Distance from foundation ____f____.Distance to nearest lot line_0__.__.__ Number of pits__ __�„---------Lining material___�_i9 _Size: Diameter----�X_rn.,____._-__Depth-----iC------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation_-------------------Lining material___---------------------------------- VA ❑ Size: Diameter-- 1-------------------- ------Depth-------------------- -----Liquid Capacity---------------------------gals. Privy: Distance from nearest well----_-----_---------------------------------------Distance from nearest building- __--_-__._________-__________----------. ❑ Distance to nearest lot line------ --------------------------------------- _ Remodelingand/or repairing (describe)---------- --------- ------------------------------------------------------••----------------•--�--------------•------------------------------------------ I . -----•--------•-------------------•---------------- ---------F -------------=------------------------------------------------------------------------------------------------------------------------------------------- -----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------I----------------------------------- --------------------------------------------------------------I I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State la s, and rules d r gulations of the San Joaquin Local Health District. (Signed}__________ _ __C ----_______- -.--__(Owner and/or Contractor) g . Title (Plot plan: showing size of lot, location of system in relation to wells, buildings, efc., can be placed on reverse side). 1 . FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED --------------------------- ------------------------------------------- DATE----- REVIEWEDBY----------------------------------------------------------------------------------- ------------------------------------------ DATE_ BUILDING PERMIT ISSUED--------------_----------------------------------------------------------------------- ------------- DATE Alterationsand/or recommendations:------------------------------- -------- ----- --------------------------•----------- --------------------••-----------------------------------•------------- -------------------------------------- -------- ..— - -- ------------ ---------- - - - ----• - ------- ------ ------- -------------- --- ---- ---------------------- ---------------------------------------------------------------•---•--- i ----------------------------------------------------- ----------------------------------------------------------- ------------------------------------------------------ -------------------------------- FINAL INSPECTION BY: -- - --- ------ Date--.-.3 � , SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton,-California Lodi, California Manteca, California Tracy, California E5-9-2M , Revised 1.57 F.P.CO.