18852 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE; P APPLICATION FOR SANITATION PERMIT Permit No. -.�-. • (Complete in Date Issued ---- ------------------ ------ - ------- From Date lssued—� i 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 : 49 l i JOB ADDRESS AND LOCATION._.!?_ Q.. -,-- ---------------------------------- Owner's Name------ . �----=---;- -•------------- -- --------------------- Phone------------------------------------ ' Address---------B.6-_j......... Contractors Name------i' } �UYI-- - --.-.•'J_-��_ L --- �5---- -VI-C-6-------.---- - -------•------ Phone----------------------------------- Installation will serve: Residence 1K Apartment House'E]- -Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: \--.--- Number of bed ooms-�-- Number of.baths ---\--- Lot size _._�`? __._ _I. --:-------------- ---- Water Supply: Public system X Community system ❑ Private ❑ Depth to Water Table _(0,0 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loa'm'❑ Clay Loam, ❑ Clay E] Adobe K Hardpan ❑ } i F Previous Application Made: I I f yes,date....................) No F. New Contstruction: Yes �, No ❑ FHA/VA: Yes ❑ Nod] TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.] �. Septic Tank: Distance from nearest well--itoWE---Distance from fou ndation_}_�._.-,_....Material-C014CI r.-L-c------------------ No. of com artments-.-.:Z-- Size__!_ 1 . Capacity 11 p .�.._..Liquid depth - ------- - P Y A- I � ( i nI VL Fm: Distance from nearest we1A%0'!�_._Distance from foundation---t.Q....0_..-.Distance to nearest lot line--S..---_-- . Number of lines___.----_------ ---_ -Len th of each line-_ -Width of trench.-__}_��._.YL-5. r__-_.- Q t FMet- 166 Type of filter material— _1Q�_�_,Depth of filter material..__kQno ____s--.-.Total length__-._?Na0__ A4_.-_-__.. Seepage Pit: Distance to nearest'wefl---kk0L4_6_-__!Distance from fundation---J-Q---F-___.Distance to nearest lot line____..----_ IB Number of pits-----`Z ...........Lining nrateriai_-Pft_ Si e: Diamete'r_A---A,-........Depth------f-6--r----------------- N Cesspool: Distance from nearest well--------------_Distance from foundation---------_---_---- Lining material____-------------------------- . ❑ Size: Diameter----------------------------------- Depth--------- --- --- ---------`- Liquid Capacity----------------------------gals. 0 ................................Distance from nearest building Privy: Distance from nearest well-------- ----------- g----------------------------------_-_-.-. ❑ Distance to nearest lot linei + '=---------------------- Remodeling and/or repairing (describe -------- ------------------ k ------------------------- ------------- ----------- ------------ -------------------------------------------------------------•------------------- -----------------------------•- I ------------- - - - - --------------------------------- ---------------------------------•----------------------------------------- ---------------;----------------------------------------- ------------------------- 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 rulesd regulation f A San Joaquin Local Health District. (signed) --------- - ------------ -------------------------- `------------- --------(Owner and/or Contractorl BY=--------------------------------------------------------------- ------- --- ------ ------------------------------------=L....._...(Title)-- ------------- ------------------------ - - - (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can 6e placed on reverse side). s FOR DEPARTMENTlUSS ONLY APPLICATION ACCEPTED BY_---�. DATE_- REVIEWED BY------------------------- ' ` . ---------- DATE------------ --------------- -------------- BUILDING PERMIT ISSUED ----- - - - D_ATE Alterations and/or recommendations:--- --------------------------------------- ------ ------------------------------- ------ •--------- ----------------- -------------------------------- ----------------------------------------------------------------------------------------------------------•---------------_-..--.---------.----...-_---..--__.--.._.--------.--__-------__-..._...__---------------------•.. ! l i ----------------------- -._....-----...--------•-----........_....-----------------------------------------......---------......------------------...._-----.....-------------------------.-----..-------- e FINAL INSPECTION BY:. --- ----------------- ------------ Date .................. l..�` ` SAN JOAQUIN LOCAL',`'HEALTH'DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California' F.P.CO. - ...._