20048 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: ------------------ APPLICATION FOR SANITATION PERMIT Permit No. ----- ------------------------------------ --- -- -------- (Complete in Duplicate) __________________ This Permit Expires I Year From Date Issued Date Issued 4 m 4190-0.S Application is hereby made to the San Joaquin Local Health District for a permit to con ruct and install the work herein described. This application is made in compliance with County Ordinance No. 549. - x JOB ADDRESS AN LOCA ION = -r------------------- -----------•---•------------ Owner's e �- --------- - - - ------------------------------------ Address__t�o=�'w--�{------------%Vu-W�+ ��'-- --- Contractor's Name-•-�#��_-- -------- `9=----- - '---- ----------------------------------- PInone__ Installation will serve: Residence [_1 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms -------- Numberof aths -------- Lot size -___. .., .----- Water Supply: Public system ❑ Community system El Private Depth to Water Table oft. Character of soil to a depth of 3 feet: Sand ❑ Gravel "� `candy Loam E] Clay Loam E] 'Clay ❑ Adobe ❑ Hardpan F]Previous Application Made: (If yes,clate_111?0�3._.a t�fNo ❑ New Construction: Yes ❑ No �FHA/VA: Yes ❑ No ❑ } TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) S c T istance from nearest well-----------------Distance from foundation--------------------Material-._.-.--_________-________---______._.--._--. No. of compartments-------------------------Size--------------- ----------------Liquid depth--------------------------Capacity..---- ---------------- � oral ield: istance from nearest well-----------------Distance from foundation.--.-.--------------Distance to nearest lot line-_---_-_-____-_._ Number of lines-----------------------------------Length of each line-----------------------------.Width of trench----- ---------------- Type ----------- --Type of filter material-------------------------Depth of filter material----------- _____.Total length-----------____-_-----_-_--_--------_-_ ,,• r- .. page it: Distance to nearest well.__ _ __©_____Distance from foundation________ ________.Distance to nearest lot line._. AA i� Number of pits----- ---------------Lining material_1l.1 -------Size. Diameter_-- -- .- ---.__--Depth....------�---______------ Cesspool: Distance from nearest well-----------------Distance fro foundation____-.-.--._---.....Lining material---._-----.-_._-.___.___-----_-- ❑ Size: Diameter------------------- - ------- --------Depth----------------------------------------------------Liquid Capacity- -----------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ ElDistance to nearest lot line-- --- --------------------------- ---------------------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe):----------------- ------- ---------r+------------------ -- --- 6 ----------------------------------------------------------------------------------------I------------------ -------------- - --��----- n ki- ------------- ---------------------------------------------------------------------------------------•.--•------------------------------------------------------------------------------------------------------------------------------- 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)..-&1 �)_1CL1L1___*_KX-__90---<s?. ; r .- (��ontractorl BY -- ---i�- ------- -- (Title) ----------------- -- -------------- (Plot plan, showing size of lot, location of system in relation t wells, buildi s, e+c., can be placed on reverse side). ,, / FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- �f -------- --L_---------------------------------------- DATE----------!__. ` f --- ---------- REVIEWED BY-------------------------------- ------ ----- ----------- - DATE-_ BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------l------------------ DATE------------------------ ---- -------------- --N---------- Alterations and/or recommendations:------�-- A- �'- -=----------- �'------------------------ >------- -----------------------------------�- ------ .. --------------- --`-='................... -- ------------------------------------------------------------------------------------ -------I-------------------------------------------------------------------------------------------------------- FINAL INSPECTION BY:_- _-_-- Date--------�-/--- '=/_./ -_ --.-------------------------- rNJOAQUIN LOCAL HEALTH DISTRICT RICT1601 E.Haxelton Ave. 3 0 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F,Rcn.