18364 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION" FOR SANITATION PERMIT Permit No. . ----------------------------------------------------------- (Complete in Duplicate) bate Issued ._____l/!_ _ .�___.__ 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. a This application is made in compliance with County Ordinance No. 549. 308 ADDRESS AND LOCATION___.___ 4l-1-------f0 �!• BcT // -------------- Owner's Name------ %Y ......... 4--/A-------------------------------- ---- Phone._' ------ Address �1 �`jg:!7j---------------------------------------------------------------------------------------------•-----------------._...------------------------------------ Contractor's Name--------- �r1 T1F�_. ---._.----5 --------- --------------- Phone_ Com_ __ �`- Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ .Motel ❑ Other ❑ Number of living units: ---I--- Number of bedrooms ,. _-_ Number of baths ___1.-- Lot.size ____ ______-_______ Water Supply: Public,system Community system ❑ Private ❑ Depth to Water Table _6q ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date.___-- ) Nox New Construction: YesXNo ❑ FHA/VA: Yes ❑ NOW TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 240 feet.) Septic Tank: Distance from nearest wel1N0*C.__Distance from foundation_..1A._.____.Mate yial_._��✓G' ± t'�__________- Ej"'�/ p.a No. of compartments___��______________Size_.$, A_i-----------Liquid depth---- ---3. ....... Disposal Field: Distance from nearest well.W. M9...Distance from foundation.--O_______.._-Distance to nearest lot line________________ Number of lines--------/-------_._. _____Length of each line------2,0................Width of trench___---- P'v Type of filter material, 'i <--Depth of filter material_______ __._Total length_________________-'O'__________ !� - .: Seepa a Pit: Distance to nearest well._,40—W ___Distance from foundation-----/.Q________-Distance to nearest lot line---- _ �DD Number of pits----------Y---------Lining matenal��I Size: Diameter__-___ ~.____Depth-----___�S'e--------_----- X Cesspool: Distance from nearest well-----------------Distance from foundation___ _______________ Lining material__._.___________....______________.__. ❑ Size: Diameter------ -- - ------ ------------------.Dept h--------------------------- -------------Liqui.d Capacity----------------------------gals. , Privy:. Distance from nearest well----------------_--------------------------------Distance from nearest building--------------------------------- ❑ Distance to nearest lot line----------------------------- ---- ---- ------ ---------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe):-----/ ,p ___.__ ___- _____ ,d __7s '1 .._ 1 _____________________ - -svAf� Q.rv�Y�-------------- ---------- --------------------------------------------------------------- c ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ro -----------------------------------------------------------------=----------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County 'r ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)---------- --- is .�/ti,• ..... ........... -------------------------.(Owner and/or Contractor) € By:----- ---------------------- --- ----- Title -- -------- ....................... { ' (Plot plan, showing size of lot, location'of system in relation o wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- / - DATE 1 �2/�S REVIEWEDBY------------------------- --------- -------- --------------------------------------------------------- DATE----------------------------- - BUILDINGPERMIT ISSUED------------------------------------------------------------------ ---------------------------------- DATE------------------------------------- ----------------------- Alterations and/or recommendations------------------------------------------------ ---------------------------•-------------------•-•--- --------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------- ------- --------- -------------- ---------------------------- ------------------------------------------------ ---------------------- ----------------------------------------------------------------------------------------------------- ----------- ------------------------------- ------------- -- ------------- -----------------------------------I----------------•------------- ---------------------------------- ----------------------------------------------- ----------------------------- I� FINAL INSPECTION BY:--- -Ems"` Date-------------� �. --------------------------- SAN JOAQUIN 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.Pxa-