18949 - Laserfiche WebLink

Home Browse Search

------------------------ APPLICATION FOR SANITATION PERMIT Permit No. ._ .r �y �1_ ----------------------------------------.----- ---------- (Complete in Duplicate) --- ------------------------------------ This Permit Expires i Year From Date Issued date Issued .- v - 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. f JOB ADDRESS AND LOCATION --------------- Owner's. NameJ_- � --� - Phone---------7-7 ,Address. / -j 1 -- -- Contractor's Name_______-- ,kr' -._- �( - - --•-••- • - ---------f-�----•-�-----•-----------•----------- ---------- ---------•-------•-----•- ---._. Phone - -------- .----------••------ ..----------•--- Installation will serve: Residences Apartment House ElCommercial [ITrailer Court E] Motel ❑ Other ❑ Number of living units: J----- Number of bedrooms Number of baths ____]C Lot size _ afer Supply: Public system ❑ Community system Private ❑f Depth to Water Table _ f____ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobeg Hardpan ❑ 1 Previous Application Made: (If yes date------ - ___.___._) No New Construction: Yes 5Z].No ❑ FHA/VA: Yes ❑y� No ❑ *fit TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is a.vai ab-le within 200 feet.) Septic Tank: Distance from nearest well__ Dazh� )ez "\Jisnce fro(foundation-----f�Q.___ _-Mpteriaf___ �_ _i1_No. of compartmenfis_ apacifiy---•-----------------Size,--j_� _- rY-- 3--- --Li Liquid de thf C Disposal � Field: Distance from nearest well_____--=......Distance from foundation___J-Z� _.___Distance to nearest lot line__=` y'-_� Number of lines-------____- _.____ .Length of each line-4—:_-Z-—____4��.Width of french_ --� `l_____ __________ ,� d Type of filter material___ . 1:=?' ' ;_,Depth of filter material_�c __ - -. 3 - -- -------------Total length-- ----�--- --------------------------- Distance Seepage Pit: to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line--------_-------- ' n ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth------ -------------------------- V' Cesspool: Distance from nearest well-----------------Distance from foundation------------.-------Lining material------------------------ d ----- t4 ❑ Size: Diameter. -------Depth-------------------------------------- -------------Liquid Capacity----------------------------gals. 4— Privy: Distance from nearest well-------------- "__c'----__--- "''.TDista`nce from nearest"building__ _---_r - ❑ Distance to nearest lot line____ - ---------- - Remodeli.ng and/or repairing (describe):_____________________ ------------------------------------------------ -----------•------------------------------------------•------•------------•----------------------------------•------••------------------------------------------------------------------------ ----------------------------- ------------------------ -- --------------------------------------------------------------------------------------------------------------------------•-------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ' ordinances, Stat laws, and rules and regulations of the San Joaquin Local Health District. [Signed}---��'- •i:_ --t�w `� � r h--------------- --------- [--- -.Owner and/or Contractor) $y::------ (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-------____-- . --- --------------------------- REVIEWED BY ----- -------------- ------------------- -�7- ---- DATE-- -- -------------------------- BUILDING PERMIT ISSUED--------------- •--------- -- --------------------------- ---------- --------------------------------------------------- ------------------------•---------- DATE.------------------------------------------------------------ Alterations and/or recommendations:_________________________ _ --------------------------------------- ------------------ ----------------------- ------ -------------------------- - - --------------------------- R,,,- FINAL INSPECTION By............ `----_--- 1.,� - j S- -----------•------------ -- Date---- ---=-------- - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 144 Sycamore Street 405 West 9Th Street Stockton,California Lodi, California Manteca,California Tracy,California 96 9 REVISED U-59 3M 3^'S3 F.P.M3.