18896 - Laserfiche WebLink

Home Browse Search

----------- G�____ _ APPLICATION FOR SANITATION PERMIT Permit No. _-�/f� --------- ---------------------------- t (Complete in Duplicate) r- -- --- This Permit Ex fires 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. I This application is made in compliance with County Ordina e No. 549. JOB ADDRESS AND LO TIOi'� �� -- ---- - f -wner's Name -------------------•----•----------- Phone ------------------------------------------ Add' ------------------------------------------------- - --------------------------------- ------ - 4G�(� --------•------•-------•--- --•------ Contractor's Name----------- / - p Installation will serve: Residence Phone________________________•_ A artment House ❑ Commercial ❑ Trailer Court Number of living units: _.1-- Number of bedrooms ❑ Motel ❑ Other ❑ _ Number of Baths --- Lot size . __- - Water Supply: Public system -- -----�----�- ------------�- .- ppy' y ❑ `Community system ❑ Private g?"1 Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam tCla Loam c> Fft: r C W .�+w.,e��,a�Y•-. ,�,/ Y ❑ Clay 0 Adobe j -, r-tardpan ❑ Previous Application Made: (If yes,date-_. .-__.1--------1 No [E New Construction: Yes ❑ NoFHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permifte`d if public sewer is available within 200 feet.) l Septic Task: 1 L}isfiance from nearest well-----------------Distance from foundation--_---------_. IVWIA W� No. of com artments_-__ - Material_'-- - _ - ) p E / Size_----•--- - --- ----- ------ q p - - } Capacity------ --------------- Disposal �F'eld: Distance from nearest well---Af1 .Distance from foundation_- __ -�__-_.Distance to nearest lot line___ ___•- �14 s / Number of lines__- � --_ - Len Length of each line__ f f.; - 9 Width of trench_•�j - -- ------- is F Type of filter material :-/; -F�,Depth of filter material--_��_______ _ Total length ------------------------------ Seepage Pit: Distance to near est well_��d"�__Distance fro fou ation___ � � _______Distance to nearest loft line__l __�_ Number of pits____l_---____--Lining material___ Size: Diameter_ % _ Cesspool: Distance from nearest well__-- ,____Distance from foundation-__-_-________ Depth- ' � �.�, _.Lining material____..------------------------------ 7 ❑ Size: Diameter ------ )-------------Depth--------- 1E ) , -------------- --------Liquid Capacity---------------------- ----- Privy: Distance from nearest well -----------------------------Distance from nearest builaing- ❑ I]istancezto nearest lot Gne__ _-.-__ _ -------------------- -- --- --------------------- T # -- - ------------------------ -- �- C Remodeling and/or repairing Idescri6e ----------------------- � ----•-------------- ------------------ g ---------------------------------------• ----------------------------------------- ----------------- --------------- -- -------------------------------- --------------- ordinances, State laws, and rules and Thereby certify that I have prepared this application and that the work will 6 e done in accordance with San Joaquin County I of the San Joaquin Local Health District. (Signed)---------------------- - ------ -- _ __ BY: ----•- t ------------------- ---- r Contractor] 1-- :- [Plat plan, showing size of lot, location of system in Pion to we s, 6uildtngs, etc., can 6e placed on reverse side). r FOR DEPARTMENT USE ONLY I APPLICATIONACCEPTED BY-------•--_-- . ----------- - ------------- --------- --- DATE----- - '7....................... BUILDING PERMIT ISSUED._-•------- -------------------------- -- -- --------- -------- ---------- -------------- - ------._ DATE----- - ------`--------- S _---- f_ �3--- '-----5 ------ - — 7----- DATEAlterations and/or recommendafions:_ ,� y - - ----------------- z ---- - ---- -- ---- t ------------------------- - - -- - - -- -- - ---------------------------- FINAL INSPECTION BY:-__- --.- _-_-__- _ f 4- --- ------------------ - Date__. -!a ------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Nazellon Ave. 300 West Oak Street T24 Sycamore Street Stockton,California ; Lodi,CaliForn;a * � � 205 West 9th Street Manteca,California i��✓ - Tracy,California i