20285 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: --------------------------------------- --------- APPLICATION FOR SANITATION PERMIT Permit No—Q----=�- - __ __ _ _____ _ (Complete in Duplicate) Date Issued -�.72�`_ � _- This Permit Expires 1 Year From 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. 4 •� /dtS ------------- -----------------•---------------------- - JOB ADDRESS AND LGCATION-------�-_Y-..------'-------- Owner's Name-__-- t .. Phone _ .�1f t =_.rAddress______ __ .. -------------------------------------------------------------------------- - --G--0 Contractor's Name------ � Phone..--_----_-----.•---------------- Installation will serve: Residence Apartment House E] Commercial E] Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms -s._ Number of baths ---I_ Lot size .-s-50_-A�l7�� Water Supply: Public system E] Private Community system Private Depth to Water Tabl - ft. t � �. Character of soil to a depth of 3 �et: Sand El Gravel [I Sandy Loam El Clay Loam [I Clay ❑ C]Adobe A Hardpan Previous Application Made: (If yes,date--:/� -7---.-1 No ❑ 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 244 feet.) SeptLr_ rii Distance fromllnearest well-----------------Distance from .foundafion.__--. --_--_.__--.Material----.----...---_-..----..--._-__-.-_--.---_.--. I� N No. of compartments---------------------- --Size--------------------------------Liquid depth--------- - -------------Capacity--•----------- Disposal Fi§'eId: Distance from nearest well----Y'-_-_.-Distance from foundation----IQ-..------Distance to nearest lot line--- - ---------- hflaNumber of lines------- ---------------:--- ----Length of each line------- ------�----Width of trench_...p` ' ------------ PiType of filter,material _Depth of filter material.__--� __.__----Total length_--.---_410------------------------- Seepage Pit: Distance to nearest well----------------------Distance from foundation-------- :'.:__.Distance to nearest lot line__.__.______..._ ❑ Number of pits-- -------------------Lining material------------------ -- Size: Diameter----------------- ----Deptk------ ------ Cesspool: Distance from nearest well-------s:-----_-Distance'from foundation.-__------- _.Lining material------------------------_--------.-- ❑ Size: Diameter-------------------- ----------------Depth°----_='-------------------------------------- Liquid Capacity gals. I -__..Distance from nearest building �\1 Privy: Distance from nearest well =---------- ------------ _=_---- ---------------- -------------- --.... nearest --------------- lot line------------------- - ------ - ------------•----------------•-----�------------•------------------------------- ❑ .t d"/or re a-r n toce od I "dam l ---- 1 Remodelin an p escribe):__ _._ (��i -----•---- �,- ................................... ----------- --------�o �- ----- .., ----- - F. } I hereby certify that I have iprepared this application and that the work will be done in accordance with San Joaquin County ordinances, Ste laws, and rules and regulations of the San Joaquin Local Health District. -------------------------------------------(O Si ned caner and/or Contractor Title ----- -------------------------------------------- ------------------------ - { ) (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 f t ----------- DATE----- ----------- APPLICATION. ACCEPTED BY-- -- ----------- ---------------- , I REVIEWED BY -;----- ----------------------------------- DATE BUILDING PERMIT ISSUED--------. --- DATE------------------ ------------------------------------------ Alterations and/or recommendations:--------------------------- ----- ---------------------------------------•-----------------"--------- -- -------------------------------------------------------------;-------------------------------------- ----- ------- ----------- --------- ----------------------------------------------------------------------�- - °--•----------------•---------- --_-------------- -------- ----------------------------------- 1 I ------------------------------------------------------ ---------- ------ ------- ------------- ------- --------- FINAL INSPECTION BY�_�. ._r.---.. .�_ - - ------- - - Date-- �..='__. . ---------- ------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazelton Ave. i 300 West Oak Street 124 Sycamore Street 205 West 91h Street t Stockton,California Lodi,California Manteca,California Tracy,California