21288 - Laserfiche WebLink

Home Browse Search

FOROFFICE USE; ---------------------- _________________________________________________________ APPLICATION FOR SANITATION PERMIT Permit No. ----------------------------- ------- ------ --- (Complete in Duplicate) ------- This Permit Ex fres 1 Year From Date Issued Date Issued �l__��_-t!� 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. f,•p _ .l`' JOB ADDRESS AND LOCATION-t�'_�-'__..C&R-_ 'R- -----��'} : (r&.___.. -----��IAK' eo------- ----- Owner's Name--- -------�'-------A��--__A_4--------------------------- - ------------------- ---- ------------- Phone----------------------------------- Address....... Contractor's Name /'7 ------•--------------------------------------------- - ------------- ---------------------------------------------- Pho e------------ ----- � 0O --- �� Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Cotel her P Number of living units: I______ Number of bedrooms A_ Number of baths _ ----- Lot size -------------------------- Water Supply: Public system ❑ Community system ❑ Privatex Depth to Water TableoZd_ ft, Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam 0 Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (if yes,date--------- ----------) Noil, New Construction: Yes 4 No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet. Septic Tank: Distance from nearest weCS49__ ___Distance from foundationJd----------- Mate ialLCl ---lcl_"15:1__________---------------- ] No. of compartments----a---- ----------Size---.XT-Y--- --------Liquid depth----- -----Z----------Capacity__f.2f1t-_-- Disposal Field: Distance from nearest well,_J70-------Distance from foundation/ Distance to nearest Igt line-__------ / Number of lines___� _____ __________. Length of each line_._// Width of trench.--'_.__._ Type of filter materia!__ __ Depth of filter material-49-______________Total length-----I2,0______________.___-_______ Seepage Pit: Distance to nearest well____------------------Distance from foundation--------------------Distance to nearest lot line------------------ I] ______._________I ] Number of pits------------------ .__Lining material----- -.- ----------- Size: Diameter-----------------------Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation___-------------.__.Lining material_____________-_______-____-._________- ❑ Size: Diameter- _ -------------- ----------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearesf building______-__-----__-_--------------_-.--. ❑ Distance to nearest lot line-- ----------------------------------------- -----------------------------------------------------------------------------,------------------ F Remodeling and/or repairing (describe):_____ �'�N_______ sem_t__� --------------------------------------•---------------------------------- ---•-------------------------------------------------------:----------------------------------- ---------------------------------------------------- . w _ F ---------- -------------------------------------------------------------------------------------------------------------------------------•----------------------------...------------------------------------------------- I 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 rules and regulations of the Sanaoaquin'Local Health District. (Signed-- -- ---------------------------- `- 4we -------------- ------------------ ----------- ------------(Owner and/or Contractor) RY� --------•-----------------------(Title)---------- ------------- - ------- ------ -------- ` (Plot plan, s owing size of loft, location of system in relaf' tbuildings, etc., can be placed on reverse side). OR EPARTMENT USE ONLY APPLICATION ACCEPTED BY' ... _------------------------- DATE__/`_ /t._ 46-(V-._ REVIEWED BY--------------------------------------------- ----------------- --------- DATE----- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE---------------------------- ------------------------------- Alterations and/or recommendations:---------------------------------------------------------------------------------------•------•- •-----•--------------- ------------------------------------ ----------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------- -------------------------------------------------•----------------------•-------------------------------------•------- ------------------------------------------------------------------------------------------- ------- -------------I---- --- - ------ -I------ - ------ ------ .--------------------------------------- - - ----------- -- ------------------------ -------------------- --- -- -------- ---------------- FINAL INSPECTION BY: ... ".. Date--------._./�..-1_r [J -- ----- --- ---- 7-------------- ---------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Av&, 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California �i {