22232 - Laserfiche WebLink

Home Browse Search

f _ . DR OFFICE USE: --- -------- ------------- APPLICATION FOR SANITATION PERMIT Permit No. _--_-- __.--_-_- .___-..-_-- --_-__--_ (CompleiFe in Duplicate) -_ This Permit Expires 1 Year From Date Issued 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 County Ordinance No. 549. JOB ADDRESS AND LOCATION____,,1-- -_---- "°> � ✓�'f'1! ` `' Owner's Name G.----e:�f��' -------------------------------- -------- Phone-------- •----------•--------••- I Address-------------- ---- ' ' +��-- Contractor's Name---/ ----------------------•-------------------------------------- ------- --------------•-------------------------------- Phone----------------------------------- Installation will serve: Residence q2 Apartment House ❑ Commercial ❑ Trailer Court ❑ /lylotel ❑ Other ❑ Number of living units;r_ ----- Number of bedrooms _3___ Number of baths__ai____ Lot size --- 44eN1�------ ------------------------ Water Supply: Public system ❑ Community system ❑ PriivateZ Depth to Water Table 4._ - ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam. n Clay ❑ Adobe ❑ Hardpan, Previous Application Made: (If yes,dote_--------_-.---__-- ) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (N septic tank or cesspool permitted if public sewer is available within 200 feet.) T Distance from nearest well-.J_17.......Distarlc from foundation--.�-o--------Material - 43� ---------------------- `�� No. of compartments-- -----Size-� ,�---- ---- ----- Liquid depth Capacity._._ -- -- . --------•--------- Disposal Field: Distance from nearest well..e -----_Distance from foundation__ __-_ r� I ��..--__---.Distance to nearest lot�llne________________ ❑ Number of lines._____I-___._-------------------Length of each line__ -V-0.-_-_ -_____ Width of trench...Ar__y___-__________-____-.-__- Type of filter materiaAl ffl�...............Depth of filter material-._-/�°_.-.-.Total len'gth__�/0-'_____________________________ Seepage Pit: Distance to nearest well--------------- ------Distance from foundation-------_-------------Distance to nearest lot line----------------- El __________---_❑ Number of pits.-- ------------------Lining material---------------------- Size: Diameter.--------------.........Depth--------------------------------- Cesspool: Distance from nearest we0 ________________Distance from foundation.-....----------- Lining material__-_.--____----____-____-.__________-. ❑ Size: Diameter --- ................Depth------------------------ - --------------Liquid Capacity------------- -------------gals. Privy: Distance from nearest well----------_-------------------------------------Distance from nearest building-'______-_______-__________---_-__---_. ❑ Distance to nearest lot line _.------------------------- ----- - ------------------------------------------------------------------------- - ------ --- Remodeling and/or repairing (describe):__- Y+---------------------- ______________________ -------- ----------------- -- -------------- ------------ ---------------------------------------------------------------------------------------------------------- -------------------- 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 San Joaquin Local Health District. (Signed)-- �- ' - .-.-..-.(Owner and/or Contrac+or) g _ —------- -------- ------ ---------- - (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -- -------------- ------------------------- -------------- DATE-- p r REVIEWEDBY--------------------------------------------------------------------------------------- --------------------------------------- DATE-------- ---------------------------------------- ---------- BUILDINGPERMIT ISSUED- ------ -- ----- ------------------------------------------------------------- ---- --------------- - DATE------------------------------------------------------------- Alterationsand/or recommendations:------------------------------ - ------------------------------------------------------------•- ----------------------=------•- ----------------------- ----- ------ --------------•-•------ ----- •- ------- ............... -------------------------------- -- • ------- -----------------I-----------------------•-------------------------------------------------- ----------------- '---------- -•------ ................ ---------------------------------------r--- -------------------------------------- -------------------------------- -- -- ---------------------------------•- ------------------ -----•-- ------ --------- - - ---- -- --- ------------------------------------------ - ----------------------------------------------- ----------- --------------------------- � �� FINAL INSPECTION BY:__r!,�,!1�'- -- -- -------- --------- - � �----- Date-. .7.--- --- - --------� - - - -------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street 5lockton,California Lodi, California _ �— Manteca,California Tracy,California E.H.9 2M 1-67 Vanguard Press E