18714 - Laserfiche WebLink

Home Browse Search

FOR Oi 1.CE USE: / 1 - .f----_---------'-� APPLICATION FOR SANITATION PERMIT Permit No. ------------ - -------------------------------- --------- (Complete in Duplicate) ' 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 Ordinance No, 549. # JOB ADDRESS ' AN ---�!� 16 Z, t Phone------------------------------------ Owners Name------ --------- Address ---- - �7-CoAddress - ----------------- Phon ntractor's Name -------------- L 4 Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer.Court ❑,a YMotel ❑ Other Number of living units: -------- Number of bedrooms -------- Number of baths/_ 0`PCdt size _____15; do --------------------------------------------- Water Supply: Public system ❑;4 Community system ❑ Private &'epth to Water Table 70- ft. Character of soil to a depth of,3,feet: Sand ❑ Gravel Eg :San ly Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date----------- .......-) No �ew Construction: Yes ffl-'-No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: s No septic tank or cesspool permitted if public sewer is available within 200 feet.) { P � P P P t � / AO L"Cal Septic Tank: Distance from nearest well_----------Distance from foundation-/A-------___.Material--- __-------________________ [G}� No. of compartments----- -:_____________Size_-3 ----------Liquid depth----��_._- --.-.--------Capacity___ _ Disposal Field: Distance from nearest -swell.., .......Distance from foundation_/_Q..........Distance to nearest lot line-----------5__e [� Number ofdines---._/__---_._--yy�-- --._. Length of each line-------�._ ?_'f----------Width of trench-.---�_5�-------------------- Type of filter materials!_/TQl�-'Depth of filter materia! _- ........ otal length--------.-.___._________ _f_______ i Seepage P' : Distance to nearest welll0--4--_-------Distanc om foundation-/,0----------Distance to nearest lot line_____J______ Number of pits-------1-__-.---_ __ _lL' --Lining material_ _ --- Diameter.-._3__$_------------De p th---- 0,-$------------- Cesspool: Distance from nearest well-------------------Distance from foundation--------------------Lining material__-.___-.-.-__.______________________ ❑ Size: Diameter--------------------- ---------------Depth------- ------------ ----------------------------Liquid Capacity-- -------------------------gals. w Privy: Distance from nearest well-_---------------__--____.______---_ ------------Distance from nearest building-----_-_----__._______________..___..___. ❑ Distance to nearest lot line-------- ------------- ------- -- - ----------------------------------- ------------------ --------------------------------- ----------- Remodelingand/or repairing (describe)------------------------------------------------------------------------------------- -------------------------------------=----------------------------- ----------------------------------------------------------------------------- is G -------------------------------------------------------------------------------------------------------------------------------------- ------ -------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ I hereby certify that I have prepared this application and'thaf the work will be done in accordance with San Joaquin County t ordinances, St to laws, and rule and regulations of the San Joaquin'Local Health District. ' (Signed)_----- --------- --- ------ ----- -- ------------------ -------------------------------------------------(Owner and/or Contractor) t. � r By:--------------------------- - ----- -Q`---=----------------- ------------------------------------------------------(Title(- s --------------- (Plot plan, showing size of lot, location of sysf in relation to wells, buildings, etc., can be placed dri reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ �� - ..�---------------------------- DATE------ --- --_......... -- -- REVIEWED BY ' � - �_ ----------------- ------------------ DATE------------ ----------•------------------------------------ BUILDING PERMIT ISSUED_---------- ---------------- �--------------._ DATE------------------------------------------ --------- Alterations and/or recommendations:.................... /_l_ - G�--___-- - C=-------- ------------ -- ------------- -- - ----------- / l`.. f Y J' t ------ ------ ------------------•------------ ----------------- ------------------------------------------ - - ------ -------------------------------------------------------------------------------------------------------------------------------------------- = Date---------- ..! ~ FINAL INSPECTION BY:-------------- = -------- ------------ `---- ----------- ----------- AN 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 r t'-o.ca.