18423 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE:--------------- F APPLICATION FOR SANITATION PERMIT Permit No. ........................3 "3 C, {Complete-in-Duplicate} �/� ------------ - - _0 ___ _ __________ ____--- This Permit l x ices 1 Year From Date Issued ' Date Issued ______ __/ __ _1_ 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 CATION___ ,; "Ze ?_-----___-__ " G . .r. . _ _ .. . _ _ _ . _ ".� Owner's Name _ _ .�0� J Phone-----------------------•--•-- Address--__a--_- r -- ----- Contractor's Name-,------- --- ---------------------•--------- -------------------------------------------- Phone----------------------------------- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel E] Other ❑ Number of living units: _/__ Number of bedrooms __ Number of baths �-- Lot size ________________________ _r Water Supply: Public system R_--co"m"munity system ❑ Private ❑ Depth to Water Table ft Character of soil to a depth of 3 feet: ,Sand ❑ Gravel ❑ Sandy Loam❑ Clay Loam ❑ IClay ❑ Adobe Z101Hardpan ❑ Previous Application'Made: [If yes,date------------- ----) No New Construction: 'Yes No ❑ 'FHA/VA: Yes [Tj-"No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank*or cesspool permitted if public sewer is available within 200 feet.) ' :. t'. It Septic Tank: Distance from nearest well----------- Distarice from fou-ndation_h�---------Material__,&_ !---- -- ------------------------ No. of comp artments_-__ ----------------Sizejx.___ __Liquid de th__- _.._.__ __Ca acit �TC�`��-____ Disposal Field: ; Distance from nearest well.-.�"___-_Distance from foundat' n__ __ Distance to nearest of line---t ____.-... (( � Number of lines-_----_A.--. ._ ength of each-liner f---- -- ��-----�.�_:-. .Width of trench-- -- -----------=------ --------- e th of filterm'aterial---fe----------Total length--Type of filter materrai_��_ p g i Seepage -t: Distance to nearest well_____°---�'-.--_____F Distance from foundation___,�� -------D-stance to pearest lot l�e___��.______-.._ = Number of its__:-�_ �__YD tn_ -- s oo : Distance from nearest well __-_-__.-g._.__Distancefrom foundationSize: Diameter_-_ _ _ ep ' N _ - Linin material- �� i * , - 'r----------------Lining material------------------------ - --------- 4 Size: Diameter-------------------------------------De th--.-�------ -- -- ---_--- - ---------- -----_Liquid Capacity----------------------....gals. Priv Distance from nearest well__________________________ Y� ---------------------Distancefrom nearest building � -----•--------------------------- !� a ❑ . Distance to nearest lot line. - = ------ ------ - ---------------- ---------------------------- Remodeii?g and/or repairing (describe):---- r i -------•------------------------------------------------------- ' - - - ------------- ----------- -------------------------------------------------------- -----_-------_ ______________________________________________________ 33 E 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, an ules and regu tions of the San Joaquin Local Health District. {Si ned g -------------- --------- - {Owner oor Contractor} ry 'ter Title '- ---- f By:. --- ------------------- { ) - (Plat plan, showing size of lot, location of syst in relation to wells, buildings, etc., can be placed on reverse side). i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------------------ ------- ----------------- - G_ DATE-------- REVIEWEDBY-------------------------------- -------- - - --------- ------------ ----------- --------- -- ------ DATE BUILDING PERMIT ISSUED-- -- --, ------ -j-- --------6---� -----�-•:------------------F------------------ DATE- ------- ---------------- -- Alterations and/or recommendations: _ -.� r - -- -:_'` T 7 -------------------------- ----------- -=------- ------- ...... ---------------------------------------1- 4 -= f- ---------------- ---------- 1------: .. =r '�---- ------`----- -r----. ....'---aP --c�-f-----`f2 fes-------------------- FINAL INSPECTION BY:.-----.- -'_-.-.- _. 1 - Date SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.14oxelton Ave. 300 West Oak Street124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca;California Tracy,California F-P.C o.