68-43 - Laserfiche WebLink

Home Browse Search

FOR OFFICE E. , 3 a Cf� , I! x. .....---- :..:-�._ _..___ _____________ APPLICATION FOR SANITATION PERMIT Permit No.1 ...................... �� ------------ ------------------------------- ----- --- (Comple+e•in'Duplicafel ----------------- # 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 Ordina ce No. 549. E JOB ADDRESS AND LOCATION _ 14-:7---, -, Owner's Name-------rC ''Ll� 441-011------ �------------------• - ---------- Phone AddressrZ 1K _ ------------------------------------------------ - t Contractor's Name-------- 1 S •-------- • ----- ------•--------- ------ •- ------------ -----�—_ .. Phone-•--------------•------------------ Installation will serve: Residence [!I'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units. _l..__ Number of bedrooms 3---- Number of baths J----- Lot size _____ ___ ________ ________ _ Water Supply: Public system Community system ❑ a Private ❑Depth to'Water Table __6 Uft Character of soil to a depth of 3 feet- Sand [] Gravel ❑ Sandy Loam ❑ FClay Loam ❑ Clay ❑ Adobe -Hardpan ❑ Previous Application Made: (if yes,date------------- J No 1511- New Construction: Yes ❑ No R�' FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic gnk.- WH F� - Distance from nearest well----------------- Distance from foundation___________________ Material y No. of compartments---•-----.. •.----- ..--Size------- ------ -----------Liquid depth------- - - . Capacity --------------- Disposal Id: Distance from nearestwelL_ v --.-_Distance from foundation.--a�.�___-_-Distance to nearest lot line_5�- ----- Nackumber of lines. .-____ .- --------------------Length of each line-_.74-_ _..____-._ Width of trench-.-!4¢ --_---Depth of filter material__— --------Total length-------- Type of filter maferial__. ______ Seepage Pit; Distance to nearest well__------------________Distance from foundation--------------------Distance to nearest lot line_.._____ ---------------- Cesspool: ❑ Number of pits..-i---------- 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 nearest building ❑ Distance to nearest lot line ------------- ----------------- Remodeling --Remodeling and/or repairing (describe):_`-_____.---_-----------------.--- -----•-----•------•-------------------------------------- ---- --------------- ------------------------------------------------------------------ --------------------------------------------------------------------- -=-----------------------•-----=----- ------------•---------------------------------------------------------------------- ----- -- --------------------------- ------------------------------------------------- -------------------------------------------------------------------- ------------------------------------------------------------ I hereby certify That I have prepared this application and fha+ the work will be done in accordance with San Joaquin County ordinances, State laws, andr es and regulations of he San Joaquin Local Health District. I (Signed) -- ---- - ---- -----=---------- - - --- - - - ---------- - ---------------------------- ----------•---------- ....--(Owner and/or Contractor) BY:----------------------------------------------- -- --------------- ....-- ---------------- (Title).---------------- -- ----.--------------(Plot plan, showing size of lot, location of system in relafion to wells, buildings, etc., can be placed on reverse side). s { FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .--------- -- ------------------------------" _ DATE .. REVIEWED BY--------------------------- -----_ - DATE BUILDING PERMIT ISSUED-------- _______ . ----------------------------------------- --- -------------------------------------- , -- _ _ ____-._ TE Alteration or rec mmendatio _____ �...... . -- � .- .� ._ -- -- ----------------- --------- - ----------.- --- --- -...._ Y FINAL. INSPECTION BY:�: -._.'W _.-- . 1 / -- -�----- Date------- - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street S!o<ktan,California Lodi, California Manteca,California Tracy, Cafifornia E.H.9 2M 1-67 Vanguard Press k